title: Cardiac magnetic resonance imaging pericardial late gadolinium enhancement and elevated inflammatory markers can predict the reversibility of constrictive pericarditis after antiinflammatory medical therapy: a pilot study.
abstract: BACKGROUND
  Constrictive pericarditis (CP) is a disabling disease, and usually requires pericardiectomy to relieve heart failure. Reversible CP has been described, but there is no known method to predict the reversibility. Pericardial inflammation may be a marker for reversibility. As a pilot study, we assessed whether cardiac magnetic resonance imaging pericardial late gadolinium enhancement (LGE) and inflammatory biomarkers could predict the reversibility of CP after antiinflammatory therapy.
  
  
  RESULTS
  Twenty-nine CP patients received antiinflammatory medications after cardiac magnetic resonance imaging. Fourteen patients had resolution of CP, whereas 15 patients had persistent CP after 13 months of follow-up. Baseline LGE pericardial thickness was greater in the group with reversible CP than in the persistent CP group (4 ± 1 versus 2 ± 1 mm, P = 0.001). Qualitative intensity of pericardial LGE was moderate or severe in 93% of the group with reversible CP and in 33% of the persistent CP group (P = 0.002). Cardiac magnetic resonance imaging LGE pericardial thickness ≥ 3 mm had 86% sensitivity and 80% specificity to predict CP reversibility. The group with reversible CP also had higher baseline C-reactive protein and erythrocyte sedimentation rate than the persistent CP group (59 ± 52 versus 12 ± 14 mg/L, P = 0.04 and 49 ± 25 versus 15 ± 16 mm/h, P = 0.04, respectively). Antiinflammatory therapy was associated with a reduction in C-reactive protein, erythrocyte sedimentation rate, and pericardial LGE in the group with reversible CP but not in the persistent CP group.
  
  
  CONCLUSIONS
  Reversible CP was associated with pericardial and systemic inflammation. Antiinflammatory therapy was associated with a reduction in pericardial and systemic inflammation and LGE pericardial thickness, with resolution of CP physiology and symptoms. Further studies in a larger number of patients are needed.
authors.affiliation: Metropolitan Heart and Vascular Institute, Minneapolis, MN, USA.
authors.forename: Dali
authors.initials: D
authors.lastname: Feng
authors.forename: James
authors.initials: J
authors.lastname: Glockner
authors.forename: Kyehun
authors.initials: K
authors.lastname: Kim
authors.forename: Matthew
authors.initials: M
authors.lastname: Martinez
authors.forename: Imran S
authors.initials: IS
authors.lastname: Syed
authors.forename: Philip
authors.initials: P
authors.lastname: Araoz
authors.forename: Jerome
authors.initials: J
authors.lastname: Breen
authors.forename: Raul E
authors.initials: RE
authors.lastname: Espinosa
authors.forename: Thoralf
authors.initials: T
authors.lastname: Sundt
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium; D006801:Humans; D018836:Inflammation Mediators / Q000037:antagonists & inhibitors* / Q000097:blood* / Q000502:physiology; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010494:Pericarditis, Constrictive / Q000097:blood* / Q000175:diagnosis*; D010496:Pericardium / Q000473:pathology; D010865:Pilot Projects; D011237:Predictive Value of Tests; D016037:Single-Blind Method
chemical_list: D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D018836:Inflammation Mediators; D005682:Gadolinium