Abstract 16165: Addition of Pericardial Delayed Hyper-enhancement by Cardiac Magnetic Resonance Imaging Increases the Diagnostic Ability of Current Guidelines to Diagnose Recurrence Among Patients With Chronic Recurrent Pericarditis
Background: Current guidelines recommend diagnosing recurrence based on chest pain, pericardial rub, EKG changes and new/worsening pericardial effusion. We hypothesized that quantified pericardial delayed hyper enhancement (DHE) has an incremental role in diagnosing recurrence.
Methods: All consecutive patients diagnosed with chronic recurrent pericarditis (RP) between January 2007 to March 2015, who had cardiac magnetic resonance imaging (CMR), echocardiography, EKG and inflammatory markers drawn on their first clinic visit were included. 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.
Results: Among 159 patients, 33(20 %) patients were diagnosed as having recurrence at the time of CMR and needed intensification of therapy by a pericardial expert.Only 16 patients (49%) were diagnosed as having recurrence* according to the guideline definition.Among patients with recurrence, 28(90%) had chest pain, 2(6%) had pericardial rub, 6(18%) had EKG changes and 15(45%) had new/increased effusion.When compared to patients without recurrence, patients with recurrence had significantly higher DHE (p<0.001), elevated inflammatory markers (p<0.02). In a multivariate stepwise logistic regression model, increased DHE was the only variable associated with recurrence (OR: 1.02; 95% CI: 1.01-1.03; p<0.001). Further, adding DHE to a diagnostic model consisting of current guideline and inflammatory markers increased the test characteristic (Figure A) and added incremental value (Figure B) with net reclassification index (NRI: 0.67; 95 % CI: 0.28-1.06;p< 0.001).
Conclusion: Pericardial DHE on MRI increased the diagnostic ability of current guidelines to diagnose recurrence in chronic RP. Further, CMR could be used as an additional tool to guide anti-inflammatory therapy.
Author Disclosures: A. Kumar: None. K. Sato: None. E. Yzeiraj: None. L. Lin: None. J. Betancor: None. C. Asher: None. S. Alkharabsheh: None. B.P. Griffin: None. D. Kwon: None. A.L. Klein: None.
- © 2016 by American Heart Association, Inc.