Abstract 13844: Quantitative Analysis of Pericardial Inflammation with Cardiac Magnetic Resonance Imaging (CMR) Predicts Outcome in Patients with Constrictive Pericarditis
Introduction: Patients with constrictive pericarditis and intense pericardial inflammation may be more likely to respond to anti-inflammatories. We hypothesized that a quantitative assessment of pericardial inflammation with CMR would better discriminate which patients would improve with medical therapy.
Methods: Consecutive symptomatic patients on anti-inflammatory therapy with echo and clinical evidence of constriction and CMR studies between January 2009 and September 2013 were included. The primary outcome was clinical resolution, defined as asymptomatic without pericardiectomy at follow-up. Inflammation was calculated as the volume of pericardium and epicardial fat on LGE that was 6 standard deviations above the signal intensity of normal myocardium. Nominal logistic regression was used to calculate the area under the receiver operating characteristic curves (AUC).
Results: Our cohort had 39 patients (56.1 ± 14.0 years) with a median follow-up of 348 days (IQR 134,597). NYHA Class was 2 (IQR 2,3), and 22 patients had chest pain. All patients had a diastolic septal bounce and either a >15% expiratory increase in early mitral inflow (n=26) or a medial e’ velocity ≤9 cm/s (n=27). Decreased age (51.8 v. 60.7 years, p = 0.02), increased NYHA class (3 v. 2, p = 0.02), chest pain (68.2% v. 31.8%, p =0.02), increased ESR (33 v. 11, p=0.01), increased LGE pericardial thickness (5 v. 4 mm, p = 0.04), and increased pericardial LGE volume (82 v. 35 mL, p < 0.001) were associated with clinical resolution. No echo variables were associated with clinical resolution. Quantitative pericardial LGE was most predictive of clinical resolution, and AUC improved when LGE was added to clinical factors and ESR (Figure 1).
Conclusions: In patients with constrictive pericarditis, a quantitative assessment of pericardial LGE predicts clinical resolution and has incremental prognostic value when added to clinical factors and ESR.
Author Disclosures: P. Cremer: None. M. Tariq: None. A. Karwa: None. A. Schuster: None. D. Kwon: None. A.L. Klein: None.
- © 2014 by American Heart Association, Inc.