Quantitative Assessment of Pericardial Delayed Hyperenhancement Predicts Clinical Improvement in Patients with Constrictive Pericarditis Treated with Anti-Inflammatory Therapy

Paul C. Cremer, Muhammad U. Tariq, Abhishek Karwa, M. Chadi Alraies, Rodolfo Benatti, Andres Schuster, Shikhar Agarwal, Scott D. Flamm, Deborah H. Kwon, Allan L. Klein

Research output: Contribution to journalArticlepeer-review

25 Scopus citations

Abstract

Background - Delayed hyperenhancement (DHE) of the pericardium usually represents ongoing inflammation and may identify patients with constrictive pericarditis that will improve with anti-inflammatory therapy. However, a quantitative assessment of pericardial DHE has not been performed, and the hierarchical relationship among clinical factors, inflammatory markers, and pericardial DHE is unknown. Methods and Results - We identified 41 consecutive patients with constrictive pericarditis who had a cardiovascular magnetic resonance study with DHE prior to the initiation of anti-inflammatory medications. 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 improvement with anti-inflammatory therapy. The mean age of our patients was 58 years, most patients were male (83%) with New York Heart Association Class II or III (59%) heart failure, and the median follow-up was 1 year. Chest pain, lower New York Heart Association class, higher Westergren sedimentation rates, and increased pericardial DHE were all significantly associated with clinical improvement (P<0.01 for all). When quantitative pericardial DHE was added to a model that included age, chest pain, New York Heart Association class, and Westergren sedimentation rates, the global χ 2 improved significantly (P=0.04 for DHE), and the area under the receiver operating characteristic curve was 0.96. Conclusions - In patients with constrictive pericarditis treated with anti-inflammatory therapy, a quantitative assessment of pericardial DHE can provide incremental information to predict clinical improvement when added to clinical factors and Westergren sedimentation rates.

Original languageEnglish (US)
Article numbere003125
JournalCirculation: Cardiovascular Imaging
Volume8
Issue number5
DOIs
StatePublished - May 21 2015

Keywords

  • constrictive pericarditis
  • magnetic resonance imaging

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