Abstract 15500: The Role of Pericardial Delayed Hyper-Enhancement in Predicting Patients With Chronic Refractory Pericarditis Needing Treatment With Disease-Modifying Antirheumatic Drugs or Biological Agents
Background: Pericardial delayed hyperenhancement (DHE) on cardiac magnetic resonance (CMR) imaging indicates chronic inflammatory pericarditis. We hypothesized that increased baseline DHE might identify patients at higher risk of developing chronic refractory recurrent pericarditis needing initiation of Disease-Modifying Antirheumatic Drugs (DMARDs) or biological agents.
Methods: This is a retrospective study of recurrent pericarditis (RP) patients who underwent DHE imaging and had follow-up. Patients already on or those started on DMARDs/Biological agents immediately after CMR were excluded. 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. Primary outcome was initiation of DMARDs/Biological agents. Secondary outcome was clinical improvement defined as successful tapering of Anti-inflammatory agents to a stable minimal dose with no recurrence for at least 3 months.
Results: Among 144 patients with RP, 31 patients (22%) were started on DMARDs/Biological agents and 59(42%) had clinical improvement at the end of follow up period. In multivariate Cox proportional-hazards model, patients with higher baseline quantitative pericardial DHE (HR: 1.01; 95 % CI: 1.00-1.02; p = 0.03) had earlier initiation of DMARDs/Biologics after adjusting for age, gender, medication use, etiology and disease activity. Kaplan-Meier curves showed that patients with quantitative DHE > 46 cm3 had significantly higher chances of being started on DMARDs/Biologics (p=0.03). Patients with lower baseline quantitative DHE had higher chances of clinical improvement (HR: 0.99; 95% CI: 0.98-0.99;p=0.006).
Conclusions: Baseline quantitative DHE predicted patients who were at higher risk of developing chronic refractory recurrent pericarditis needing DMARDs/Biologics.
Author Disclosures: K. Sato: None. A. Kumar: None. E. Yzeiraj: None. J. Betancor: None. L. Lin: None. V. Raizada: None. D.H. Kwon: None. A. Kontzias: None. A.L. Klein: None.
- © 2016 by American Heart Association, Inc.