Skip to main content

Advertisement

Log in

Transient Constrictive Pericarditis: Current Diagnostic and Therapeutic Strategies

  • Pericardial Disease (AL Klein, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Transient constrictive pericarditis is increasingly recognized as a distinct sub-type of constrictive pericarditis. The underlying pathophysiology typically relates to impaired pericardial distensibility, associated with acute or sub-acute inflammation, rather than the fibrosis or calcification often seen in chronic pericardial constriction. Accordingly, patients may present clinically with concomitant features of pericarditis and constrictive physiology. Non-invasive multimodality imaging is advocated for diagnosis of transient constrictive pericarditis. Echocardiography remains the mainstay for initial evaluation of the dynamic features of constriction. However, cardiac magnetic resonance imaging can provide complimentary functional information, with the addition of dedicated sequences to assess for active pericardial edema and inflammation. Although transient pericardial constriction can spontaneously resolve, institution of anti-inflammatory therapy may hasten resolution or even prevent progression to chronic pericardial constriction. Non-steroidal anti-inflammatory agents remain the initial treatment of choice, with subsequent consideration of colchicine, steroids, and other immune-modulating agents in more refractory cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Sagrista-Sauleda J, Permanyer-Miralda G, Candell-Riera J, Angel J, Soler-Soler J. Transient cardiac constriction: an unrecognized pattern of evolution in effusive acute idiopathic pericarditis. Am J Cardiol. 1987;59:961–6.

    Article  CAS  PubMed  Google Scholar 

  2. Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015;36(42):2921–64. Current and comprehensive European Society of Cardiology guidelines for the diagnosis and management of pericardial diseases.

    Article  PubMed  Google Scholar 

  3. Maeda K, Saito S, Toda T, Ueno T, Kuratani T, Sawa Y. Transient constrictive pericarditis following cardiac surgery. Ann Thorac Cardiovasc Surg. 2014;20(Suppl):897–900.

    Article  PubMed  Google Scholar 

  4. Feng D, Glockner J, Kim K, et al. Cardiac magnetic resonance imaging pericardial late gadolinium enhancement and elevated inflammatory markers can predict the reversibility of constrictive pericarditis after antiinflammatory medical therapy: a pilot study. Circulation. 2011;124:1830–7. Important paper demonstrating the utility of cardiac magnetic resonance imaging in predicting those with constrictive pericarditis who benefit from anti-inflammatory therapy.

    Article  CAS  PubMed  Google Scholar 

  5. Allaria A, Michelli D, Capelli H, Berri G, Gutierrez D. Transient cardiac constriction following purulent pericarditis. Eur J Pediatr. 1992;151:250–1.

    Article  CAS  PubMed  Google Scholar 

  6. Woods T, Vidarsson B, Mosher D, Stein JH. Transient effusive-constrictive pericarditis due to chemotherapy. Clin Cardiol. 1999;22:316–8.

    Article  CAS  PubMed  Google Scholar 

  7. Haley JH, Tajik AJ, Danielson GK, Schaff HV, Mulvagh SL, Oh JK. Transient constrictive pericarditis: causes and natural history. J Am Coll Cardiol. 2004;43:271–5.

    Article  PubMed  Google Scholar 

  8. Imazio M, Brucato A, Maestroni S, et al. Risk of constrictive pericarditis after acute pericarditis. Circulation. 2011;124:1270–5.

    Article  PubMed  Google Scholar 

  9. Taylor AM, Dymarkowski S, Verbeken EK, Bogaert J. Detection of pericardial inflammation with late-enhancement cardiac magnetic resonance imaging: initial results. Eur Radiol. 2006;16:569–74.

    Article  PubMed  Google Scholar 

  10. Syed FF, Ntsekhe M, Mayosi BM, Oh JK. Effusive-constrictive pericarditis. Heart Fail Rev. 2013;18:277–87.

    Article  PubMed  Google Scholar 

  11. Talreja DR, Edwards WD, Danielson GK, et al. Constrictive pericarditis in 26 patients with histologically normal pericardial thickness. Circulation. 2003;108:1852–7.

    Article  PubMed  Google Scholar 

  12. Klein AL, Abbara S, Agler DA, et al. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr. 2013;26:965–1012 e15. Current recommendations from the American Society of Echocardiography, highlighting the importance of multi-modality imaging in the assessment of pericardial disease.

    Article  PubMed  Google Scholar 

  13. Ha JW, Oh JK, Ling LH, Nishimura RA, Seward JB, Tajik AJ. Annulus paradoxus: transmitral flow velocity to mitral annular velocity ratio is inversely proportional to pulmonary capillary wedge pressure in patients with constrictive pericarditis. Circulation. 2001;104:976–8.

    Article  CAS  PubMed  Google Scholar 

  14. Reuss CS, Wilansky SM, Lester SJ, et al. Using mitral ‘annulus reversus’ to diagnose constrictive pericarditis. Eur J Echocardiogr. 2009;10:372–5.

    Article  PubMed  Google Scholar 

  15. Bogaert J, Francone M. Cardiovascular magnetic resonance in pericardial diseases. J Cardiovasc Magn Reson. 2009;11:14.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Cremer PC, Tariq MU, Karwa A et al. Quantitative assessment of pericardial delayed hyperenhancement predicts clinical improvement in patients with constrictive pericarditis treated with anti-inflammatory therapy. Circ Cardiovasc Imaging 2015;8. Recent manuscript presenting novel quantitative methods for assessment of pericardial delayed enhancement by cardiac magnetic resonance imaging.

  17. Imazio M, Brucato A, Cemin R, et al. A randomized trial of colchicine for acute pericarditis. N Engl J Med. 2013;369:1522–8. Important manuscript highlighting the benefit of colchicine use in the setting of acute pericarditis.

    Article  CAS  PubMed  Google Scholar 

  18. Imazio M, Brucato A, Cumetti D, et al. Corticosteroids for recurrent pericarditis: high versus low doses: a nonrandomized observation. Circulation. 2008;118:667–71. Valuable paper addressing the issue of corticosteroid dosing in recurrent pericarditis.

    Article  CAS  PubMed  Google Scholar 

  19. Jain S, Thongprayoon C, Espinosa RE et al. Effectiveness and Safety of Anakinra for Management of Refractory Pericarditis. Am J Cardiol 2015. Recent comprehensive manuscript addressing the benefits and issues related to prescription of anakinra for refractory pericarditis.

  20. Scardapane A, Brucato A, Chiarelli F, Breda L. Efficacy of an interleukin-1beta receptor antagonist (anakinra) in idiopathic recurrent pericarditis. Pediatr Cardiol. 2013;34:1989–91.

    Article  PubMed  Google Scholar 

  21. Finetti M, Insalaco A, Cantarini L, et al. Long-term efficacy of interleukin-1 receptor antagonist (anakinra) in corticosteroid-dependent and colchicine-resistant recurrent pericarditis. J Pediatr. 2014;164:1425–31. e1.

    Article  CAS  PubMed  Google Scholar 

  22. Baskar S, Klein AL, Zeft A. The use of IL-1 receptor antagonist (Anakinra) in idiopathic recurrent pericarditis: a narrative review. Cardiology Research and Practice. 2016;2016:1–6.

    Article  Google Scholar 

  23. Imazio M, Gaita F, LeWinter M. Evaluation and treatment of pericarditis: a systematic review. JAMA. 2015;314:1498–506.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christine L. Jellis.

Ethics declarations

Conflict of Interest

James Gentry, Christine L. Jellis, and Allan L. Klein declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

James Gentry and Allan L. Klein are co-authors

This article is part of the Topical Collection on Pericardial Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gentry, J., Klein, A.L. & Jellis, C.L. Transient Constrictive Pericarditis: Current Diagnostic and Therapeutic Strategies. Curr Cardiol Rep 18, 41 (2016). https://doi.org/10.1007/s11886-016-0720-2

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11886-016-0720-2

Keywords

Navigation