Good Prognosis for Pericarditis With and Without Myocardial Involvement

Abstract

Background— The natural history of myopericarditis/perimyocarditis is poorly known, and recently published studies have presented contrasting data on their outcomes. The aim of the present article is to assess the prognosis of myopericarditis/perimyocarditis in a multicenter, prospective cohort study. Methods and Results— A total of 486 patients (median age, 39 years; range, 18–83 years; 300 men) with acute pericarditis or a myopericardial inflammatory syndrome (myopericarditis/perimyocarditis; 85% idiopathic, 11% connective tissue disease or inflammatory bowel disease, 5% infective) were prospectively evaluated from January 2007 to December 2011. The diagnosis of acute pericarditis was based on the presence of 2 of 4 clinical criteria (chest pain, pericardial rubs, widespread ST-segment elevation or PR depression, and new or worsening pericardial effusion). Myopericardial inflammatory involvement was suspected with atypical ECG changes for pericarditis, arrhythmias, and cardiac troponin elevation or new or worsening ventricular dysfunction on echocardiography and confirmed by cardiac magnetic resonance. After a median follow-up of 36 months, normalization of left ventricular function was achieved in >90% of patients with myopericarditis/perimyocarditis. No deaths were recorded, as well as evolution to heart failure or symptomatic left ventricular dysfunction. Recurrences (mainly as recurrent pericarditis) were the most common complication during follow-up and were recorded more frequently in patients with acute pericarditis (32%) than in those with myopericarditis (11%) or perimyocarditis (12%; P <0.001). Troponin elevation was not associated with an increase in complications. Conclusions— The outcome of myopericardial inflammatory syndromes is good. Unlike acute coronary syndromes, troponin elevation is not a negative prognostic marker in this setting.

Clinical Profile and Influences on Outcomes in Patients Hospitalized for Acute Pericarditis

“…9 The mean age of patients with acute pericarditis in clinical series has ranged from 41 to 60 years, 5,10-12 but sex-associated differences in age have not been reported. The prognosis for viral/ idiopathic pericarditis is good, 12 but purulent and tuberculosis pericarditis have high mortality. 13 Female sex has been associated with complications after acute pericarditis, 14 but this little is known about the effect of age.…”

Acute pericarditis

“…The long-term prognosis for patients who have idiopathic pericarditis with associated myocarditis is excellent. 7,8 The evolution to constrictive pericarditis is rare in idiopathic or viral acute pericarditis (<0.5%), although not negligible. For other specific etiologies it is much more common, such as 2.8% in pericarditis related to connective tissue diseases, 4.0% in tumors, 20% in tuberculosis and 33% in purulent pericarditis.…”

“…This may have an intermittent character, so it is important to conduct a series of physical examinations. 8 …”

“…5 In a study of 254 patients, the use of ASA in patients with uncomplicated pericarditis relieved the symptoms in 87% of cases. 8 Non-steroidal anti-inflammatory drugs (NSAIDs) should be used in the initial period of 7 to 14 days, and treatment duration depends on clinical improvement and normalization of levels of inflammatory markers, such as CRP and ESR. Ibuprofen is also widely used because it does not interfere with the coronary flow.…”

“…1,8 Little is known about the pathophysiology of recurrent pericarditis. Some patients have no evidence of pericardial inflammation during recurrences, and it is unclear whether patients with recurrences have an active viral infection or an immunological basis for the syndrome.…”