Cardiac magnetic resonance in pericardial disease

Methods CMR was performed in 146 patients (85 males, aged 56 ±16 years) with clinical suspicion of acute pericarditis (AP, n=46), pericardial effusion without inflammation (PE, n=47), and constrictive pericarditis (CP, n=53). Final diagnosis was ascertained by a combined evaluation of different CMR sequences. Patients were followed-up for all-cause and cardiac death. Results The final diagnosis was AP in 56 patients (38%), PE in 38 (26%), and CP in 42 (29%). Pericardial disease was excluded in 7 patients (5%), with CMR evidence of abundant epicardial fat. The initial diagnosis was changed by CMR in 21% of patients. Initial suspicion was confirmed in 40/46(87%) patients with AP suspicion (alternative CP diagnosis: 2, PE: 1; no pericardial disease: 3). PE was confirmed by CMR in 35/47(75%) patients (10 with a final AP diagnosis, 2 patients with absent pericardial disease). A CP diagnosis was confirmed in 40/53(75%), while 6 presented signs of AP (resembling a “transient constrictive pericarditis”), 5 PE (as “effusiveconstrictive pericarditis”), and 2 showed no pericardial disease. At Kaplan-Meyer analysis, on a 551-day median follow-up (IQ range 330-1110), patients diagnosed with CP had a worse prognosis than AP or PE patients (P <0.001).