Aetiology, Treatment and Outcomes of Pericarditis: Long-Term Data from a Longitudinal Retrospective Single-Centre Cohort

Abstract

Background. Pericarditis has a heterogeneous clinical spectrum and rate of relapse. Data on aetiology, real-life treatment strategies, and long-term course from contemporary pericarditis cohorts are lacking. Methods. Pericarditis patients referred to the Cardioimmunology Outpatient Clinic at Padua University Hospital in 2001-2020 were retrospectively included. Kaplan-Meier method was used for recurrence-free survival probability estimation. The appropriateness of treatment was assessed based on the European Society of Cardiology guidelines. Results. One-hundred forty-four patients (57% males, mean age 50 years) followed up for 18 months (IQR 7-45) were included; of those, 52% had acute, 35% recurrent, 8% incessant, and 5% chronic pericarditis; 9% had cardiac tamponade at diagnosis. Time to pericardial effusion resolution was 53 days (IQR 16-124); median medical treatment duration was 87 days (IQR 48-148). Treatment was readjusted following the ESC guidelines for nonsteroidal anti-inflammatory drugs in 29% of the cases, steroids in 12%, and colchicine in 25%. Eleven (8%) patients were treated with anti-IL1 agents. Recurrence-free survival probability was 86% at 1st-year follow-up, and 23 patients (16%) had at least one recurrence, with a mean of two relapses per patient. Compared to patients without recurrences, they had a higher frequency of cardiac tamponade (27% vs. 6%, p = 0.006) and left bundle branch block (14% vs. 1%, p = 0.034). Out of the 144 patients, 5 (3%) were diagnosed as having constrictive pericarditis at first evaluation at our clinic, underwent successful pericardiectomy, and are currently alive and asymptomatic. Conclusions. When treated following a guideline-based approach, pericarditis has a favourable evolution. A relevant quote of cases benefits from the treatment readjustment of previously prescribed medical therapy when not in line with ESC recommendations. Cases relapsing despite treatment readjustment should receive anti-IL1 therapies.

Keywords: acute pericarditis; anti-inflammatory therapy; cardioimmunology; immunosuppressive therapy; interleukin-1 blockade.

Figure 1

ECG and echocardiographic findings in different patients with acute pericarditis. Typical ECG findings in a patient with acute pericarditis, presenting to the emergency department because of continuous chest pain worsening when breathing and easing when leaning forwards. Panel (A) shows a previous normal ECG of the same patient, and Panel (B) shows the ECG registered at the admission for acute pericarditis, with concave ST-segment elevation in the inferolateral leads (blue arrows) with associated PR-segment depression. Panels (C) (subcostal view), (D) (parasternal short axis view), and (E) (apical 3 chamber view) show the echocardiographic features of severe pericardial effusion (anechoic space between the pericardial layers, red arrows).

Figure 2

Recurrence-free survival probability.

Figure 3

Echocardiographic findings of a patient with constrictive pericarditis. Echocardiographic findings of a patient with long-standing worsening right-sided heart failure. Panels (A,B) show an “annulus reversus” pattern on tissue Doppler imaging (TDI) evaluation (medial e’ velocity, yellow arrow; > lateral e’ velocity, green arrow; on same velocity reference scale). Panel (C) shows moderate circumferential pericardial effusion, more represented at the left ventricular posterior wall (red arrows). Panel (D) shows dilated and hypo-collapsible inferior vena cava.