The incidence of adverse outcomes was found to be high in acute pericarditis, and to be greater in patients with a subacute presentation and idiopathic etiology, according to a study published in Chest.

A total of 240 patients (median age, 51 years; 56% men; 50.4% Caucasians; 41.7% African Americans) who presented with acute pericarditis to the Virginia Commonwealth University Medical Center were included in the study. Pericarditis was determined to be idiopathic in 53% of patients and related to cardiac injury in 33% of cases.

During a median follow-up of 179 days, 34% of patients had ≥1 adverse outcome (ie, included cardiac tamponade, constrictive pericarditis, failure of therapy, and recurrences or death). Patients with postcardiac injury vs idiopathic pericarditis had a lower incidence of a composite of failure of treatment and recurrence (13% vs 26%, respectively; P =.022).


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Participants with and without adverse had comparable baseline demographic characteristics and pericarditis etiology for qualifying events. Patients who had an adverse outcome were more likely to have subacute presentation (12.2% vs 1.3%, respectively; odds ratio 10.7; 95% CI, 2.3-50.1; P =.001).

Of the 167 patients (70%) for whom troponin I measurements were obtained, elevated levels were associated with a lower incidence of recurrences (4% vs 17%, respectively; P =.024) and of the composite outcome (13% vs 36%, respectively; P =.004).

Study limitations include its retrospective nature and single-center design.

“The measurement of serum troponin I levels could be useful to recognize patients with elevated levels who are paradoxically at lower risk [for] failure of treatment, recurrences, constrictive pericarditis, tamponade, or death,” noted the researchers. “However, it remains unclear how to tailor the treatment plan for those with abnormal troponin I values. Further prospective studies are warranted to better define the time window and characteristic of subacute onset of pericarditis and may aid in identifying pathophysiological mechanisms of and targeted therapy for idiopathic and postcardiac injury pericarditis.”

Disclosures: Some of the study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.

Reference

Vecchié A, Chiabrando JG, Dell MS, et al. Clinical presentation and outcomes of acute pericarditis in a large urban hospital in the United States of America [published online July 24, 2020]. Chest. doi:https://doi.org/10.1016/j.chest.2020.07.039