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New Insights into Pericarditis: Mechanisms of Injury and Therapeutic Targets

  • Pericardial Disease (AL Klein, Section Editor)
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Abstract

Purpose of Review

This review article aims to provide a contemporary insight into the pathophysiological mechanisms of and therapeutic targets for pericarditis, drawing distinction between autoinflammatory and autoimmune pericarditis.

Recent Findings

Recent research has focused on the distinction between autoinflammatory and autoimmune pericarditis. In autoinflammatory pericarditis, viruses can activate the sensor molecule of the inflammasome, which results in downstream release of cytokines, such as interleukin-1, that recruit neutrophils and macrophages to the site of injury. Conversely, in autoimmune pericarditis, a type I interferon signature predominates, and pericardial manifestations coincide with the severity of the underlying systemic autoimmune disease. In addition, autoimmune pericarditis can also develop after cardiac injury syndromes. With either type of pericarditis, imaging can help stage the inflammatory state. Prominent pericardial delayed hyperenhancement on magnetic resonance imaging suggests ongoing inflammation whereas calcium on computed tomography suggests a completed inflammatory cascade. In patients with ongoing pericarditis, treatments that converge on the inflammasome, such as colchicine and anakinra, have proved effective in recurrent autoinflammatory pericarditis, though further clinical trials with anakinra are warranted.

Summary

An improved understanding of the pathophysiological mechanisms of pericarditis helps unravel effective therapeutic targets for this condition.

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  1. Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Desk J1-5, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Bo Xu, Serge C. Harb & Paul C. Cremer

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  1. Bo Xu
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Correspondence to Paul C. Cremer.

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Bo Xu, Serge C. Harb, and Paul C. Cremer declare that they have no conflict of interest.

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This article is part of the Topical Collection on Pericardial Disease

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Xu, B., Harb, S.C. & Cremer, P.C. New Insights into Pericarditis: Mechanisms of Injury and Therapeutic Targets. Curr Cardiol Rep 19, 60 (2017). https://doi.org/10.1007/s11886-017-0866-6

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