From the Guidelines
CTA of the coronary arteries is not the primary diagnostic tool for pericarditis, but it may be useful in certain cases where there is diagnostic uncertainty or suspicion of coronary involvement, as it can provide valuable information on coronary anatomy and non-coronary cardiac and vascular findings attributable to COVID-19. According to the expert consensus statement published in JACC: Cardiovascular Imaging in 2020 1, coronary computed tomography angiography (CTA) may be preferred in athletes who have ongoing chest pain after COVID-19 or other concerns for ischemic myocardial damage, due to its excellent negative predictive value. However, for suspected pericarditis, an echocardiogram is typically the first-line imaging study, followed by cardiac MRI if needed.
Some key points to consider when using CTA for coronary arteries in the context of pericarditis include:
- Coronary CTA can reveal important non-coronary cardiac and vascular findings attributable to COVID-19, such as pericardial thickening and hyperattenuation in patients with active pericarditis 1.
- CTA may also provide some evaluation of the lung parenchyma, although the field of view is limited to the heart 1.
- A "one-stop-shop" approach that includes imaging of the entire thorax as well as evaluation of coronary, aortic, pulmonary artery, and myocardial pathology may be useful in certain cases 1.
- However, CTA involves radiation exposure and contrast agents, and may not provide as much information about pericardial inflammation as echocardiography or MRI 1.
In terms of treatment, the focus should be on managing pericarditis symptoms and reducing inflammation, rather than solely relying on CTA for diagnosis. Treatment typically includes NSAIDs, colchicine, and rest, with corticosteroids reserved for refractory cases or specific etiologies. The use of CTA should be reserved for cases where there is diagnostic uncertainty or suspicion of coronary involvement, and should be guided by clinical judgment and expertise.
From the Research
CTA Coronary Arteries and Pericarditis
- The relationship between CTA coronary arteries and pericarditis is not directly addressed in the provided studies, which focus on the treatment of pericarditis.
- However, pericarditis can be related to coronary arteries in the sense that coronary artery disease can lead to pericarditis, especially in cases of myocardial infarction 2.
- The treatment of pericarditis typically involves anti-inflammatory medications such as aspirin, NSAIDs, colchicine, and corticosteroids 2, 3, 4, 5, 6.
- Colchicine has been shown to be effective in reducing the incidence of recurrent pericarditis, with a number needed to treat of 4-5 3, 4, 6.
- The use of colchicine, in addition to NSAIDs, has been found to reduce the risk of recurrent pericarditis by 50-60% 3, 6.
- Other treatments, such as anti-interleukin-1 agents, have also been found to be effective in reducing recurrences of pericarditis, especially in cases refractory to conventional treatment 6.
Treatment Options
- Aspirin and NSAIDs are commonly used as first-line treatment for pericarditis 2, 5, 6.
- Colchicine is often used as an adjunctive therapy to NSAIDs to reduce the risk of recurrent pericarditis 2, 3, 4, 5, 6.
- Corticosteroids may be used in cases of recurrent pericarditis or in patients who are intolerant to NSAIDs or colchicine 2, 5.
- Anti-interleukin-1 agents, such as anakinra and rilonacept, may be used in cases of recurrent pericarditis refractory to conventional treatment 6.