015 esc guidelines for the diagnosis and management of pericardial diseases

8/18/2019 015 ESC Guidelines for the Diagnosis and Management of Pericardial Diseases

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). New role of markers of inflammation (especially Creacti!e protein" to confirm the

diagnosis and monitor the activity of the disease: this will help to individuali'e the therapy

and provide duration of the anti$inflammatory therapy till symptoms resolution and

normali'ation of C$reactive protein.

*. New role of imaging to assess pericardial inflammation. !ericardial inflammation can be identified by CT "contrast$enhancement of the inflamed pericardium# but especially by

C+R that allows detecting pericardial oedema on T$weighted imaging and pericardial late

gadolinium enhancement as e-pression of organi'ing pericarditis. n atypical of doubtful

presentations this will allow reaching the diagnosis of pericarditis.

/. Triage of pericarditis. &pecific features at presentation have been identified as ma%or poor

prognostic predictors "fever)C, subacute course, large pericardial effusion, cardiac

tamponade, lac2 of response to empiric anti$inflammatory therapy# that could be helpful to

identify patients at high ris2 of complications and non$idiopathic or non$viral aetiologies to

be admitted and investigated. Additional features may re3uire monitoring: associated

myocarditis, immunodepression or immunosuppression, trauma, and oral anticoagulanttherapy. 4ow ris2 cases without these features can be managed as outpatient.

5. New therapeutic schemes and dosing for acute pericarditis. 6igh doses of anti$

inflammatory every hours till symptoms resolution and C$reactive protein normali'ation

will help to improve remission rates and reduce recurrences especially with the ad%unct of

colchicine on top of standard anti$inflammatory therapies "table #.

Table 2. Therapeutic schemes for acute pericarditis


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7. Therapeutic algorhytm for recurrent pericarditis. Aspirin and 8&A( plus colchicine

are mainstay of therapy for acute and recurrent pericarditis. Corticosteroids are a second

option to be considered in patients not responding to first line therapies or for specific

indications "e.g. pregnancy, systemic inflammatory diseases already on corticosteroids#. n

cases that do not respond to these therapies or a combination of them, emerging options are

highlighted: a'athioprine, 9, and ana2inra. !ericardiectomy is the last option in

e-perienced centres ";igure 1#.


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. Triage of pericardial effusion. n cases with cardiac tamponade or a suspicion of a

bacterial or neoplastic aetiology pericardiocentesi is indicated as well as admission.


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>. Transient constricti!e pericarditis. 8ew$onset constrictive pericarditis may be transient

and cured by empiric anti$inflammatory therapy in case of pericarditis "e.g. evidence of

elevated C$reactive protein or pericardial inflammation on imaging# thus preventing

pericardiectomy.

10. Specific management issues for children and pregnancy. &pecific indications,

contraindications and therapeutic schemes are proposed for children, pregnant women but

also elderly and in case of hepatic or renal disease.

n conclusion these new guidelines will promote a more evidence$based management of

pericardial disease and will assist the clinician in everyday clinical practice.

#eferences

1. Authors?Tas2 ;orce +embers, Adler @, Charron !, ma'io +, et al. 01/ &C uidelines

for the diagnosis and management of pericardial diseases: The Tas2 ;orce for the (iagnosis

and +anagement of !ericardial (iseases of the uropean &ociety of Cardiology

"&C#ndorsed by: The uropean Association for Cardio$Thoracic &urgery "ACT. ur


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6eart B. 01/ 8ov 7)5"*#:>1$5*. doi: 10.10>)?eurheart%?ehv)1. pub 01/ Aug >.

!ub+ed !+(:

. +aisch D, &eferoviE !+, RistiE A(, rbel R, RienmFller R, Adler @, Tom2ows2i GH,

Thiene , @acoub +6 Tas2 ;orce on the (iagnosis and +anagement of !ricardial (iseases

of the uropean &ociety of Cardiology. uidelines on the diagnosis and management of pericardial diseases e-ecutive summary The Tas2 force on the diagnosis and management of

pericardial diseases of the uropean society of cardiology. ur 6eart B. 00* Apr/"7#:/7$

510. !ub+ed !+(: 1/100/5.

The content of this article reflects the personal opinion of the author?s and is not necessarily

the official position of the uropean &ociety of Cardiology.

015 esc guidelines for the diagnosis and management of pericardial diseases

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