Multimodality imaging in patients with post-cardiac injury syndrome

Abstract

This review article is focused on the role of echocardiography, cardiac CT and cardiac magnetic resonance (CMR) imaging in diagnosing and managing patients with post-cardiac injury syndrome (PCIS). Clinically, the spectrum of pericardial diseases under PCIS varies not only in form and severity of presentation but also in the timing varying from weeks to months, thus making it difficult to diagnose. Pericarditis developing after recent or remote myocardial infarction, cardiac surgery or ablation if left untreated or under-treated could worsen into complicated pericarditis which can lead to decreased quality of life and increased morbidity. Colchicine in combination with other anti-inflammatory agents (non-steroidal anti-inflammatory drugs) is proven to prevent and treat acute pericarditis as well as its relapses under various scenarios. Imaging modalities such as echocardiography, CT and CMR play a pivotal role in diagnosing PCIS especially in difficult cases or when clinical suspicion is low. Echocardiography is the tool of choice for emergent bedside evaluation for cardiac tamponade and to electively study the haemodynamics impact of constrictive pericarditis. CT can provide information on pericardial thickening, calcification, effusions and lead perforations. CMR can provide pericardial tissue characterisation, haemodynamics changes and guide long-term treatment course with anti-inflammatory agents. It is important to be familiar with the indications as well as findings from these multimodality imaging tools for clinical decision-making.

RETRACTED: Prevalence, Predictors, and Clinical Presentation of Acute Pericardial Effusion Following Percutaneous Coronary Intervention

“…Interestingly, the signs of a systemic inflammatory response have also been observed after the implantation of stents. This response has the specific name of post-cardiac injury syndrome (PCIS) ( 17 ). In our study, the level of plasma hs-CRP before PCI was significantly higher in patients with PE than in patients without PE and corresponded with the elevation of TnT, both measures reflect myocardial involvement and inflammatory status.…”

Post‐cardiac injury syndrome after surgical repair of atrial septal defect: Reporting a rare occurrence

“…Indications for ASD closure in childhood are well documented, and treatment is known to be effective 3 . Complications including development of cardiac tamponade, recurrent pericardial effusion or pericardial effusions requiring drainage after ASD closure are rare 1,4–6 . Furthermore, these pericardial complications are usually reported in the peri‐procedure period, as compared to our patient who developed symptoms several months after surgery 7 .…”

“…Ongoing inflammation at the epicardial level results in an inflammatory cascade (Figure 4). 1,2 Indications for ASD closure in childhood are well documented, and treatment is known to be effective. 3 Complications including development of cardiac tamponade, recurrent pericardial effusion or pericardial effusions requiring drainage after ASD closure are rare.…”

“…1 Cardiac surgery is the most common cause (10%-40%) followed by electrophysiology procedures (1%-2%), and coronary intervention (.1%-1%). 1 The clinical presentation is varied as symptoms may develop even after a few years therefore making diagnosis and associated management difficult. Here, we present a case of an adolescent male who developed PCIS induced recurrent pericarditis (RP) after surgical repair of an atrial septal defect (ASD).…”

Novel Pharmacotherapies for Recurrent Pericarditis: Current Options in 2020

“…Once elicited, pleuropericarditis can be monophasic or recurrent. Pathogenesis is poorly understood, although it is likely to include autoinflammation and autoimmunity similarly to IRP [65]. Accordingly, post-cardiac injury recurrent pericarditis can be management similarly to IRP, as recently reviewed by Verma et al [65].…”