The Contemporary Role of Cardiac Computed Tomography and Cardiac Magnetic Resonance Imaging in the Diagnosis and Management of Pericardial Diseases

Conte, Edoardo; Agalbato, Cecilia; Melotti, Eleonora; Marchetti, Davide; Schillaci, Matteo; Ratti, Angelo; Ippolito, Sonia; Pancrazi, Massimo; Perone, Francesco; Dalla, Alessia; Pepi, Mauro; Imazio, Massimo; Brucato, Antonio; Chetrit, Michael; Klein, Allan L.; Andreini, Daniele

doi:10.1016/j.cjca.2023.01.030

Canadian Journal of Cardiology

2023

DOI: 10.1016/j.cjca.2023.01.030

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The Contemporary Role of Cardiac Computed Tomography and Cardiac Magnetic Resonance Imaging in the Diagnosis and Management of Pericardial Diseases

Edoardo Conte¹,

Cecilia Agalbato²,

Eleonora Melotti³

et al.

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Cited by 4 publications

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“…If the tests were found positive for ongoing pericardial inflammation, or supposed in the case of CRP, the reduction was postponed, and 1 more month of therapy was administered before the reduction. 4 , 5 …”

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confidence: 99%

Serial cardiac magnetic resonance imaging for guidance of therapy management in patients treated with anakinra due to recurrent pericarditis

Bianco,

Bucciarelli,

Coretti

et al. 2024

European Heart Journal - Imaging Methods and Practice

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Aims To determine the utility of serial cardiac magnetic resonance (CMR) imaging for guidance of therapy management in patients treated with anakinra due to recurrent pericarditis (RP), compared with c-reactive protein (CRP) assay alone. Methods and results In 2018-21, we enrolled 18 (14.5±1.8-year-old, 72% males) consecutive RP patients treated with anakinra (100 mg/day in patients ≥ 18 years old; 2 mg/kg/day < 18 years old) due to RP corticosteroid-dependent, or not responsive to colchicine or non-steroidal anti-inflammatory drugs. After hospitalization, they were 1:1 randomized to CMR [no pericardial edema and/or late gadolinium enchantment (LGE)] or CRP (<0.6 mg/dL). Tests were repeated every 3-months until negative to halve the anakinra dosage and cessation. The idiopathic etiology was the most prevalent (n=8, 44%), followed by postpericardiotomy (n=6, 33%). After a median treatment period of 8.7±3.6 months, CRP-guided RP patients experienced more recurrences than CMR-guided ones (6 vs. 1, P=0.016), with the worst prognosis in terms of recurrences (Log-rank, P= 0.025) and significant increased time of treatment (12.7±2 vs. 16.1±3.4 months, P=0.019). In a multivariable exploratory Cox regression model, the number of previous recurrences and the idiopathic etiology were independent predictors of RP during the anakinra treatment. New recurrences were subsequently directed to CMR imaging, and therapy modified according to the LGE/edema trend. After 1-year follow-up, no further recurrence was detected. Conclusions Among patients with RP and treated with anakinra, serial CMR imaging of the pericardium can be utilized as an imaging biomarker, more informative for therapy duration than the solely CRP assessment. ClinicalTrials.gov ID NCT06071156

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mentioning

confidence: 99%

Serial cardiac magnetic resonance imaging for guidance of therapy management in patients treated with anakinra due to recurrent pericarditis

Bianco,

Bucciarelli,

Coretti

et al. 2024

European Heart Journal - Imaging Methods and Practice

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Unveiling the Spectrum of Pericardial Diseases: Insights, Novelties, and Future Directions

Mardigyan¹,

Imazio²,

Brucato³

et al. 2023

Canadian Journal of Cardiology

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Longitudinal cardiac magnetic resonance imaging following clinical response to rilonacept and prior to recurrence upon treatment suspension: a RHAPSODY subgroup analysis

Cremer,

Brucato,

Insalaco

et al. 2024

European Heart Journal - Cardiovascular Imaging

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Aims In the phase 3 trial, RHAPSODY, rilonacept effectively resolved active pericarditis recurrences, and long-term treatment led to sustained pericarditis recurrence risk reduction. Prior analysis suggested association between higher late gadolinium enhancement (LGE) at baseline and more rapid recurrence upon rilonacept suspension after 12 weeks of treatment. This subgroup analysis assessed the utility of longitudinal serial cardiac magnetic resonance (CMR) imaging for tracking clinical improvement and predicting post-treatment-cessation outcomes to help guide clinical decision making. Methods and Results At an 18-month decision milestone (18MDM) in the RHAPSODY long-term extension, investigators decided if patients would continue rilonacept, suspend rilonacept for off-treatment observation, or discontinue the study. Pericardial thickness, pericardial edema (T2-STIR), and LGE were determined at baseline and 18MDM by an imaging core lab blinded to clinical data, and pericarditis recurrence was investigator-assessed. CMR results in patients with data at both baseline and 18MDM (n=13) showed that pericardial thickness, T2-STIR, and LGE were reduced during rilonacept treatment. Among patients with CMR data who suspended rilonacept at the 18MDM (n=7), 5 (71%) had a pericarditis recurrence within 1–4 months of rilonacept suspension, despite all having had none/trace LGE (n=7) and negative T2-STIR (n=7) at the 18MDM and 2 having received prophylactic colchicine. Conclusions Continued clinical improvement during prolonged rilonacept treatment corresponded with improvement on CMR, including reduced pericardial thickness, resolution of pericardial edema, and resolution of LGE. However, none/trace LGE at 18MDM while on treatment did not predict absence of pericarditis recurrence upon subsequent rilonacept suspension in this size-limited subgroup.

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The Contemporary Role of Cardiac Computed Tomography and Cardiac Magnetic Resonance Imaging in the Diagnosis and Management of Pericardial Diseases

Cited by 4 publications

References 31 publications

Serial cardiac magnetic resonance imaging for guidance of therapy management in patients treated with anakinra due to recurrent pericarditis

Serial cardiac magnetic resonance imaging for guidance of therapy management in patients treated with anakinra due to recurrent pericarditis

Unveiling the Spectrum of Pericardial Diseases: Insights, Novelties, and Future Directions

Longitudinal cardiac magnetic resonance imaging following clinical response to rilonacept and prior to recurrence upon treatment suspension: a RHAPSODY subgroup analysis

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