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Heart failure and cardiomyopathies
Original research article
Quantitative assessment of pericardial delayed hyperenhancement helps identify patients with ongoing recurrences of pericarditis
  1. Arnav Kumar1,
  2. Kimi Sato2,
  3. Beni Rai Verma2,
  4. Chandra Kanth Ala2,
  5. Jorge Betancor2,
  6. Edlira Yzeiraj2,
  7. Lin Lin2,
  8. Divyanshu Mohananey2,
  9. Salima Qamruddin2,
  10. Apostolos Kontzias3,
  11. Michael A Bolen4,
  12. Massimo M Imazio5,
  13. Deborah H Kwon2,
  14. Rory Hachamovitch2 and
  15. Allan L Klein2
  1. 1 Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
  2. 2 Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
  3. 3 Department of Rheumatology, Cleveland Clinic, Cleveland, Ohio, USA
  4. 4 Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
  5. 5 University Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
  1. Correspondence to Dr Allan L Klein; kleina{at}ccf.org

Abstract

Objectives Recurrences of pericarditis (RP) are often difficult to diagnose due to lack of clinical signs and symptoms during subsequent episodes. We aimed to investigate the value of quantitative assessment of pericardial delayed hyperenhancement (DHE) in diagnosing ongoing recurrences of pericarditis.

Methods Quantitative DHE was measured in 200 patients with established diagnosis of RP using cardiac MRI. Conventional clinical criteria for diagnosis of pericarditis were ≥2 of the following: chest pain, pericardial rub, ECG changes and new or worsening pericardial effusion.

Results A total of 67 (34%) patients were identified as having ongoing episode of recurrence at the time of DHE measurements. In multivariable analysis, chest pain (OR: 10.9, p<0.001) and higher DHE (OR: 1.32, p<0.001) were associated with ongoing recurrence of RP. Addition of DHE to conventional clinical criteria significantly increased the ability to diagnose ongoing recurrence (net reclassification improvement (NRI): 0.80, p<0.001; integrated discrimination improvement (IDI): 0.12, p<0.001). Among 150 patients with history of RP who presented with chest pain, higher DHE was still independently associated with ongoing recurrence (OR: 1.28, p<0.001), showed incremental value over clinical criteria (NRI: 0.76, p<0.001; IDI: 0.13, p<0.001) and demonstrated a sensitivity of 70% and specificity of 74%.

Conclusion Among patients with RP, quantitative DHE provided incremental information to diagnose ongoing recurrences over conventional clinical criteria of pericarditis. Quantitative DHE demonstrated acceptable test characteristics to diagnose ongoing recurrence even in RP patients presenting with chest pain.

  • pericarditis
  • magnetic resonance imaging
  • cardiac imaging techniques
  • recurrence
  • pericardial delayed hyperenhancement

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

https://doi.org/10.1136/openhrt-2018-000944

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    Footnotes

    • AK and KS contributed equally.

    • Contributors AK and KS: conception of the study, data collection, data analysis and writing the manuscript. BRV, CKA, JB, EY and LL: data collection and critical review of the manuscript. DM, SQ, AK, MAB and MMI: critical review of the manuscript. DHK: conception of quantitative DHE methodology, review of data, critical review of the manuscript. RH: data analysis and critical review of the manuscript. ALK: critical review of the manuscript and responsible for the overall content as guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Cleveland Clinic Foundation.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.