Quantitative Pericardial Delayed Hyperenhancement Informs Clinical Course in Recurrent Pericarditis.
The aim of this study was to evaluate the prognostic value of quantitative assessment of pericardial delayed hyperenhancement (DHE) among patients with recurrent pericarditis (RP).



Pericardial DHE on cardiac magnetic resonance may persist beyond the acute phase of pericarditis, suggesting continued pericardial inflammation.



This is a retrospective cohort study of 159 patients with RP who underwent DHE imaging and had a follow-up period of more than 6 months. Pericardial inflammation was quantified on short-axis DHE sequences by contouring the pericardium, selecting normal septal myocardium as a reference region, and then quantifying the pericardial signal that was >6 SD above the reference. Our primary outcome was clinical remission; secondary outcomes were time to recurrence and recurrence rate.



The mean age of our patients was 46 ± 14 years, and 52% were women. During a median follow-up period of 23 months (interquartile range: 15 to 34 months), 32 (20%) patients achieved clinical remission. In the multivariable Cox proportional hazards model, lower quantitative pericardial DHE (hazard ratio: 0.77; 95% confidence interval: 0.64 to 0.93; p = 0.008) was independently associated with clinical remission. When added to background clinical and laboratory variables, quantitative pericardial DHE had incremental prognostic value over baseline clinical and laboratory variables (integrated discrimination improvement: 8%; net reclassification improvement: 36%). Furthermore, patients with a higher quantitative DHE had shorter time to subsequent recurrence (p = 0.012) and had a higher recurrence rate at 6 months (p = 0.026).



Quantitative assessment of pericardial DHE was associated with clinical outcomes among patients with RP and provided incremental information regarding the clinical course of patients with RP.
Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio.
Arnav
A
Kumar
Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio.
Kimi
K
Sato
Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio.
Edlira
E
Yzeiraj
Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio.
Jorge
J
Betancor
Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio.
Lin
L
Lin
Heart Institute, Cedars Sinai Medical Center, Los Angeles, California.
Balaji K
BK
Tamarappoo
Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio.
Deborah H
DH
Kwon
Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio.
Rory
R
Hachamovitch
Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio. Electronic address: kleina@ccf.org.
Allan L
AL
Klein
D000328:Adult; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000008:administration & dosage; D015150:Echocardiography, Doppler; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010493:Pericarditis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D003287:Contrast Media; D019786:Gadolinium DTPA
cardiac magnetic resonance; clinical remission; delayed hyperenhancement; recurrent pericarditis