Abstract 12546: Pericardial Delayed Hyperenhancement with Magnetic Resonance Imaging Predicts Inflammation: A Histopathologic Correlation.
Background: Some constrictive pericarditis (CP) patients studied by cardiac magnetic resonance imaging (CMR) show pericardial delayed hyperenhancement (DHE) following gadolinium contrast administration. The aim of this study was to examine the prevalence and histopathologic correlates of pericardial DHE among CP patients undergoing pericardiectomy.
Methods: We identified 25 CP patients who underwent pericardiectomy following CMR- gadolinium study. Ten control subjects with no evidence of pericardial disease, who were referred for cardiac viability imaging, were also assessed. A 14-segment pericardial model was utilized to determine pericardial DHE score and thickness score. Microscopic slides were reviewed and evaluated for the presence of calcification, fibrosis, inflammation, granulation tissue, fibrin deposition, hemosiderin and mesothelial hyperplasia and all histology findings were subsequently graded on a 4-point scale.
Results: DHE was present in 12 (48%) of CP patients (DHE+ group), but absent in 13 CP patients (DHE- group) and in all control subjects. DHE+ group showed greater fibroblastic proliferation, more prominent chronic inflammation and neovascularization, and a trend towards more prominent granulation tissue (Figure 1). Fibroblastic proliferation and chronic inflammation prominence correlated with DHE intensity quantitated by DHE score (Spearman's r = 0.578, p<0.002 and r=0.590, p<0.002 respectively) but not with pericardial thickness.
Conclusions: The presence of pericardial DHE on CMR is a unique and frequent phenomenon in CP. Its presence is associated with histological markers of chronic inflammation.
- © 2010 by American Heart Association, Inc.