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  • 1
    Online Resource
    Online Resource
    Role of non-invasive multimodality imaging in autoimmune pericarditis
    Oxford University Press (OUP) ; 2021
    In:  European Heart Journal - Cardiovascular Imaging Vol. 22, No. 11 ( 2021-10-19), p. 1228-1240
    Details
    In: European Heart Journal - Cardiovascular Imaging, Oxford University Press (OUP), Vol. 22, No. 11 ( 2021-10-19), p. 1228-1240
    Abstract: Systemic autoimmune diseases are an important cause of pericardial involvement and contribute to up to ∼22% cases of pericarditis with a known aetiology. The underlying mechanism for pericardial involvement varies with each systemic disease and leads to a poor understanding of its management. Multimodality imaging establishes the diagnosis and determines the type and extent of pericardial involvement. In this review, we elaborate upon various pericardial syndromes associated with different systemic autoimmune and autoinflammatory diseases and the multitude of imaging modalities that can be used to further characterize autoimmune pericardial involvement. Lastly, these forms of pericarditis have a greater likelihood of recurrence, and clinicians need to understand their unique treatment approaches to improve patient outcomes.
    Type of Medium: Online Resource
    ISSN: 2047-2404 , 2047-2412
    URL: Article
    DOI: 10.1093/ehjci/jeab131
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2042482-6
    detail.hit.zdb_id: 2647943-6
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  • 2
    Online Resource
    Online Resource
    Abstract 12735: Autoimmune Recurrent Pericarditis in Pregnancy: A Multidisciplinary Approach
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Background: Recurrent pericarditis in pregnancy is uncommon and the data regarding the safety and efficacy of conventional therapy is sparse. We describe a multidisciplinary approach to managing a challenging case of chronic, recurrent pericarditis in the setting of newly-diagnosed systemic lupus erythematosus (SLE) and pregnancy. Case: 28-year-old female at 24 weeks gestation with no known medical history presents with sharp, pleuritic and positional chest pain and hypotension. Transthoracic echocardiography reveals acute, effusive pericarditis with features of tamponade. Despite emergent pericardiocentesis, pericardial window placement and treatment with steroids, she had recurrence of pericarditis the following month. Due to the recurrent nature of pericarditis of unknown etiology and pregnancy, clinicians were faced with a diagnostic and therapeutic dilemma. Decision Making: After extensive testing to rule out malignancy, bacterial and fungal infections, she was diagnosed with SLE - the culprit of her recurrent pericarditis. An multidisciplinary approach among cardiology, rheumatology and obstetrics was taken to determine an optimal therapeutic regimen and several risk-benefit discussions were conducted with the patient and family. In order to treat both recurrent pericarditis and SLE, she was tapered off of steroids initiated on Azathioprine 50 mg and low-dose Colchicine 0.3 mg twice daily. She was followed closely with cardiac MRI (Figure 1) and ultimately delivered a healthy child despite her new diagnoses. Conclusion: This case showcases the complexity of managing recurrent pericarditis in the setting of pregnancy and comorbid conditions and supports the use of Colchicine and Azathioprine for this population despite the lacking literature. This case also emphases the importance of multidisciplinary teamwork, clinical acumen and the value of patient-centered care when determining a course of therapy for a challenging patient.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.12735
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1466401-X
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  • 3
    Online Resource
    Online Resource
    Clinical characteristics, evaluation and outcomes of chylopericardium: a systematic review
    BMJ ; 2023
    In:  Heart Vol. 109, No. 17 ( 2023-09), p. 1281-1285
    Details
    In: Heart, BMJ, Vol. 109, No. 17 ( 2023-09), p. 1281-1285
    Abstract: Chylopericardium (CPE) is a rare condition associated with accumulation of triglyceride-rich chylous fluid in the pericardial cavity. Due to minimal information on CPE within the literature, we conducted a systematic review of all published CPE cases to understand its clinical characteristics, management and outcomes. Methods We performed a literature search and identified cases of patients with CPE from 1946 until May 2021 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We identified relevant articles for pooled analyses of clinical, diagnostic and outcome data. Results A total of 95 articles with 98 patients were identified. Patient demographics demonstrated male predominance (55%), with a mean age of 37±15 years. Time from symptom onset to diagnosis was 5 (Q1 4.5, Q3 14) days, with 74% of patients symptomatic on presentation. Idiopathic CPE (60%) was the most common aetiology. Cardiac tamponade secondary to CPE was seen in 38% of cases. Pericardial fluid analysis was required in 94% of cases. Lymphangiography identified the leakage site in 59% of patients. Medical therapy (total parenteral nutrition, medium-chain triglycerides or octreotide) was undertaken in 63% of cases. In our cohort, 32% progressed towards surgical intervention. During a median follow-up of 180 (Q1 180, Q3 377) days, CPE recurred in 16% of cases. Of the patients with recurrence, 10% were rehospitalised. Conclusion CPE tends to develop in younger patients and may cause serious complications. Many patients fail medical therapy, thereby requiring surgical intervention. Although overall mortality is low, associated morbidities warrant close follow-up and possible reintervention and hospitalisations.
    Type of Medium: Online Resource
    ISSN: 1355-6037 , 1468-201X
    URL: Article
    DOI: 10.1136/heartjnl-2022-321798
    Language: English
    Publisher: BMJ
    Publication Date: 2023
    detail.hit.zdb_id: 2378689-9
    detail.hit.zdb_id: 1475501-4
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  • 4
    Online Resource
    Online Resource
    Abstract 15397: Pericardial Delayed Hyperenhancement Predicts Outcomes in Idiopathic Recurrent Pericarditis
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Recurrent pericarditis (RP) is defined as recurrence of pericarditis after an initial documented episode of pericarditis and symptom free interval of four to six weeks. In this study, we aimed to investigate the prognostic value of the pericardial delayed hyperenhancement (DHE) in patients with idiopathic recurrent pericarditis (IRP). Hypothesis: We hypothesize that moderate to severe DHE is correlated with worse outcomes. Methods: Consecutive patients (n=223) with IRP from 2012-2019 were included. Out of 223 patients, 213 had DHE tracing. Patients were then followed for events of clinical improvement (CI), clinical remission (CR), and clinical recurrence. Results: The mean age of the 223 patients included was 45 ± 16 years, and 51% were females. DHE was divided into two groups none/mild (n=160) and moderate/severe (n=53). At baseline, median number of prior recurrences was 3 (Q1, Q3: 2,5). Furthermore, when adjusted for age, gender, prior number of recurrences, and anti-inflammatory therapy on multivariable cox-regression analysis, moderate to severe DHE was independently associated with less likelihood of having CI (HR 0.24, p 〈 0.001) and CR (HR 0.31, p=0.011), and more likelihood of having clinical recurrence (HR 1.58, p=0.02). On Kaplan Meier analysis, moderate to severe DHE was associated with more time to clinical improvement (log rank p 〈 0.0001), more time to clinical remission (log rank p 〈 0.0001), and less time to clinical recurrence (log rank p=0.0047). Conclusions: Moderate to severe DHE is independently correlated with worse outcomes in patients with IRP. DHE should be considered an important part of evaluation in patients with recurrent pericarditis and should be included in new guidelines. Our study will help clinicians utilize DHE as a prognostic marker in patients with IRP.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.15397
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1466401-X
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