Prediction of reversibility of constrictive pericarditis by magnetic resonance imaging

The usual treatment of constrictive pericarditis is pericardiectomy. But constriction can also be reversible in certain instances. Feng D and associates have conducted a pilot study to assess whether inflammatory markers and late gadolinium enhancement (LGE) of pericardium on cardiac magnetic resonance imaging can predict reversibility of constrictive pericarditis with anti inflammatory treatment [Cardiac Magnetic Resonance Imaging Pericardial Late Gadolinium Enhancement and Elevated Inflammatory Markers Can Predict the Reversibility of Constrictive Pericarditis After Antiinflammatory Medical Therapy. Circulation. 2011; 124: 1830-1837]. Almost half of their twenty nine patients with constrictive pericarditis had reversal with anti inflammatory treatment after a follow up of thirteen months. Baseline LGE pericardial thickness was more in those with reversible constriction. The intensity of pericardial LGE was moderate or severe in majority (93%) of the group with reversible constriction while it was only noted in one third of those with persistent constriction. Pericardial thickness of 3 mm or more on cardiac magnetic resonance imaging LGE had 86% sensitivity and 80% specificity for predicting reversible constriction. High levels of inflammatory markers like C-reactive protein and erythrocyte sedimentation rate were also noted in the the group with reversible constriction. Authors concluded that reversible constrictive pericarditis was associated with evidence of pericardial and systemic inflammation. These cases responded to anti inflammatory therapy with resolution of symptoms and constrictive physiology. The pericardial thickness assessed by LGE cardiac magnetic resonance imaging as well as pericardial and systemic inflammation were reduced with this therapy.