From the Guidelines
Transient constrictive pericarditis should be evaluated through a combination of imaging studies, including echocardiography, cardiac MRI, and CT scanning, along with clinical assessment and laboratory tests, even in the absence of a flare-up, to monitor for ongoing inflammation and potential disease progression. When evaluating transient constrictive pericarditis without an active flare-up, it's crucial to consider the patient's overall clinical presentation and history. According to the 2015 ESC guidelines for the diagnosis and management of pericardial diseases 1, a temporary form of constriction usually develops with pericarditis and mild effusion and resolves with anti-inflammatory therapy within several weeks. Key components of the evaluation include:
- Echocardiography with Doppler studies to assess for pericardial thickening and ventricular interdependence
- Cardiac MRI to detect pericardial inflammation and thickening with high sensitivity
- CT scanning to measure pericardial thickness and identify calcification
- Hemodynamic assessment via cardiac catheterization to evaluate for constrictive physiology
- Laboratory tests, including inflammatory markers (ESR, CRP), to monitor for ongoing inflammation These evaluations are essential for tracking disease progression or resolution and for early detection of potential complications, allowing for timely and effective treatment interventions.
From the Research
Evaluation of Transient Constrictive Pericarditis
In the absence of a flare-up, transient constrictive pericarditis can be evaluated using various imaging modalities, including:
- Magnetic Resonance (MR) imaging, which provides precise delineation of the pericardial thickness, evaluation of ventricular function, and detection of wall motion abnormalities 2
- Echocardiography with elevated central venous pressure, which can aid in diagnosing constrictive pericarditis more accurately than chest CT scans 3
- Cardiovascular magnetic resonance (CMR) imaging, which is useful for addressing the challenges of confirming the diagnosis of constrictive pericarditis and can exclude other causes of right heart failure 4, 5
- Cardiac Magnetic Resonance (CMR) with tissue characterization, which allows evaluation of the functional and flow changes in pericardial constriction and detection of acute pericardial inflammation, fusion, and thickening of pericardial layers, and pericardial effusion 6
Diagnostic Approach
The diagnostic approach for transient constrictive pericarditis may involve:
- A multiparametric CMR approach to evaluate the initial diagnostic suspicion and distinguish between active inflammation, chronic pericarditis with constriction, and effusion without inflammation 6
- Invasive biventricular pressure measurements to confirm the diagnosis of constrictive pericarditis 5
- Echocardiography to detect signs such as septal bounce and shudder, which can prompt further investigation 5
Key Findings
Key findings that may suggest transient constrictive pericarditis include:
- Abnormal thickening or rigidity of the pericardium, which may compromise normal cardiac function 2
- Impaired diastolic cardiac function caused by a calcified and thickened pericardium 3
- Increased signal intensity on short tau inversion recovery (STIR) sequences and late gadolinium imaging, which can indicate pericardial inflammation and constriction 4