Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Nov 18;4(12 Pt 2):102335.
doi: 10.1016/j.jacadv.2025.102335. Online ahead of print.

Investigating Pericarditis Diagnosis in a Tertiary Pericardial Center: A Descriptive Study

Abdel Hadi El Hajjar  1 , Ziad Zalaquett  1 , Akiva Rosenzveig  1 , Alveena Batool Syed  1 , Astefanos Al-Dalakta  1 , Zoha Majeed  1 , Michael Villalonga  1 , Jibran Ikram  1 , Muhammad Ehsan  1 , Issam Motairek  1 , Mary Heine  1 , Felix Berglund  1 , Tom Kai Ming Wang  1 , Allan Klein  2
Affiliations

Investigating Pericarditis Diagnosis in a Tertiary Pericardial Center: A Descriptive Study

Abdel Hadi El Hajjar et al. JACC Adv. .

Abstract

Background: Pericarditis diagnosis can be challenging due to its nonspecific presentation, which may lead to frequent misdiagnosis.

Objectives: In this study, the authors aimed to report the rate of misdiagnosed pericarditis and describe the characteristics of these patients.

Methods: Between September 2022 and September 2023, patients referred to the Pericardial Center with a diagnosis of pericarditis were enrolled in a prospective registry. Data were collected using a standardized history and physical examination template. Diagnosis was established according to the 2015 European Society of Cardiology guidelines. The prevalence of misdiagnosed pericarditis was calculated. Demographics, comorbidities, symptoms, laboratory results, and imaging were compared between the accurately diagnosed (group 1) and misdiagnosed pericarditis cohorts (group 2).

Results: A total of 170 patients were included; the mean age was 49.1 years. Thirty-five percent of patients were misdiagnosed. Demographics were similar in both groups. Significant differences were found between group 1 and group 2) in coronary artery disease (17.3% vs 5.0%, P = 0.02), valvular disease (23.6% vs 8.3%, P = 0.01), and atrial fibrillation (24.5% vs 6.7%, P < 0.01). Significant late gadolinium enhancement on magnetic resonance imaging, raised inflammatory markers, electrocardiogram changes, and specific pericardial pain were more common in the accurately diagnosed group (P < 0.05). COVID-19 infection was significantly higher in the misdiagnosed group (16.7% vs 6.4%, P < 0.05), whereas cardiac surgery was significantly lower (3.3% vs 18.2%, P < 0.05).

Conclusions: Thirty-five percent of patients referred to the pericardial center are misdiagnosed with pericarditis. Inflammatory markers and late gadolinium enhancement on magnetic resonance imaging can help refine the diagnosis. COVID-19 infection is associated with higher rates of misdiagnosis.

Keywords: LGE-MRI; long-COVID; misdiagnosis; pericarditis.

PubMed Disclaimer

Conflict of interest statement

Funding support and author disclosures Dr Klein receives research grants from Kiniksa, Cardiol Therapeutics, and Ventyx Scientific; and serves on the advisory Boards of Kiniksa, Cardiol Therapeutics, and Ventyx Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Study Design
Figure 2
Figure 2
Comparison of Precipitating Factors Between Misdiagnosed and Accurately Diagnosed Pericarditis Patients
Figure 3
Figure 3
Comparison of Diagnostic Criteria Between Misdiagnosed and Accurately Diagnosed Pericarditis Patients CRP = C-reactive protein; EKG = electrocardiogram; ESR = erythrocyte sedimentation rate; MRI = magnetic resonance imaging.
Figure 4
Figure 4
Alternative Diagnoses Established in Patients With Misdiagnosed Pericarditis. GI = gastrointestinal.
Central Illustration
Central Illustration
Pericarditis Diagnosis at a Tertiary Pericardial Center Pericarditis was misdiagnosed in 35% of cases referred to a tertiary pericardial center, where the evaluation and diagnosis were made according to the gold standard 2015 ESC guidelines. MRI enhancement, inflammatory markers, EKG changes, typical pericardial chest pain, and a history of cardiac surgery were more common in the accurately diagnosed group, while a history of SARS-CoV-2 was more common in the misdiagnosed group. Clinical history and objective measures like LGE on MRI may therefore help in refining pericarditis diagnosis. EKG = electrocardiogram; ESC = European Society of Cardiology; LGE = late gadolinium enhancement; MRI = magnetic resonance imaging.
See this image and copyright information in PMC

References

    1. Adler Y., Charron P., Imazio M., et al. 2015 ESC guidelines for the diagnosis and management of pericardial diseases: the task force for the diagnosis and management of pericardial diseases of the european society of cardiology (ESC)Endorsed by: the european association for cardio-thoracic surgery (EACTS) Eur Heart J. 2015;36(42):2921–2964. - PMC - PubMed
    1. Chiabrando J.G., Bonaventura A., Vecchié A., et al. Management of acute and recurrent pericarditis: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75(1):76–92. - PubMed
    1. Gouriet F., Levy P.-Y., Casalta J.-P., et al. Etiology of pericarditis in a prospective cohort of 1162 cases. Am J Med. 2015;128(7):784.e1–784.e8. - PubMed
    1. Imazio M., Hoit B.D. Post-cardiac injury syndromes. An emerging cause of pericardial diseases. Int J Cardiol. 2013;168(2):648–652. - PubMed
    1. Agrawal A., Berglund F., Kumar A.K., et al. Adverse prognosis in patients with postcardiac injury syndrome-related recurrent pericarditis: effect of gender. JACC Adv. 2023;2(4) - PMC - PubMed

LinkOut - more resources