Multimodality imaging for the diagnosis and treatment of constrictive pericarditis

ABSTRACT

Introduction: Constrictive pericarditis can result in debilitating congestive right heart failure and has been considered an important cause of morbidity and mortality in patients with cardiovascular disease. Multimodality imaging continues to play a fundamental role in the individual approach to diagnosis, management, and prognosis of patients with this clinical syndrome.

Areas covered: This article gives an overview of the clinical spectrum of constrictive pericardial diseases and the role of multimodality imaging in the diagnosis of constrictive pericarditis. There is a focus on the emerging role of cardiac magnetic resonance (CMR) for the diagnosis, management, and prognostication of patients with constrictive pericarditis based on more recent case series, retrospective and prospective studies, which have helped to define the role of CMR.

Expert opinion: Advanced multimodality imaging assists with identification of both overt and subclinical pericardial inflammation. This allows the pericardiologist to recognize patients with potentially reversible disease, trial medical therapy, and thereby avoid mechanical removal of the pericardium. Further, pericardial characterization by CMR has provided novel information about the natural history of these pericardial conditions, which can help tailor therapy and improve prognosis.

KEYWORDS:

• Cardiac magnetic resonance
• constrictive pericarditis
• delayed hyperenhancement
• inflammation
• pericardium

Article highlights

• Echocardiography remains the initial imaging modality of choice for the diagnosis of constrictive pericarditis with a focus on respirophasic septal shift and annulus reversus.

• Cardiac computed tomography is the gold standard for the assessment of pericardial calcium burden.

• Cardiac MRI is an important tool for the diagnosis of pericardial inflammation and the diagnosis of transient and effusive constrictive pericarditis.

• Pericardial characterization and the presence of pericardial inflammation suggests reversibility of the underlying constrictive physiology and provides important prognostic information.

• Cardiac MRI has contributed to our understanding of the natural history of inflammatory pericardial conditions associated with constrictive physiology.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.