Response to Letter Regarding Article, “Good Prognosis for Pericarditis With and Without Myocardial Involvement: Results From a Multicenter, Prospective Cohort Study”

Myopericarditis in tuberculous pericardial effusion: prevalence, predictors and outcome

“…In a contemporary Western European series of acute pericarditis, with myopericarditis diagnosed on similar criteria to the current study, the prevalence was 25% and over 90% of cases were idiopathic or autoimmune 14. Similar to our findings, ST elevation was more commonly seen with myopericarditis (OR = 5.4, 95% CI 1.4 to 20.5, p = 0.013).…”

“…HIV-associated cardiomyopathy is strongly associated with a CD + cell count less than 100 cells/µL and other potential causes include myocarditis from opportunistic infections or sepsis syndrome and cytokine mediated LV dysfunction 15. This is an area of ongoing research, with modalities such as cardiac MRI which can provide superior tissue characterisation to echocardiography and identify the exact nature of TB myocardial involvement,16 similar to what has been reported on myopericarditis in Western European series 14…”

“…The distinction between myopericarditis, in which there is pericarditis with evidence of some myocardial involvement (usually without LV dysfunction), and perimyocarditis, in which there is myocarditis with pericardial involvement (often with depressed LV function), may have implications for management and outcomes 14. In our study 15% (7/43) of participants labelled as myopericarditis had moderate or severe LV dysfunction; all were alive at 6 months suggesting that the LV dysfunction had little if any negative impact on mortality.…”

“…The 6-month case fatality rate of 18% was consistent with outcome in TB pericarditis,5 and there was no statistically significant difference between those with and without myopericarditis. Myocarditis is not associated with increased mortality in non-TB forms of pericarditis,14 and it is possible that this also applies to TB pericarditis. However, the small sample size of this study may not provide a definitive answer to this question.…”

Diagnosis and treatment of pericarditis

“…In clinical practice it is often detected by elevation of markers of myocardial lesion (ie, troponins) assessed for the differential diagnosis with an acute coronary syndrome. These cases usually with preserved left ventricular function are commonly labeled as myopericarditis 7 8…”