Cardiac magnetic resonance is a marker of active inflammation in constrictive pericarditis

The diagnosis of constrictive pericarditis (CP) is problematic and there is limited data on the role of cardiac magnetic resonance imaging (CMR) with late gadolinium enhancement (LGE) and inflammatory markers in the diagnosis and management of CP. We sought to study the correlation of CMR LGE and inflammatory markers with disease activity of CP and response to treatment. We identified 59 patients (mean age 52 ± 10 years, 64% female) with confirmed medically managed CP between 2007 and 2010 who had serial CMR and high sensitivity C-reactive protein (hs-CRP) at baseline and follow-up (26 ± 16 weeks). At baseline, LGE was absent in 9 patients (18%) (Group 1) and present in 50 (84%) (Group 2). Patients in Group 2 had worse heart failure symptoms, higher baseline hs-CRP levels, and were more likely to be treated with prednisone and colchicine (Table 1). On follow-up CMR, none of the patients in Group 1 demonstrated LGE while the patients in Group 2 showed reduction. There was a significant decrease in heart failure symptoms and hs-CRP in Group 2 (P = 0.01). In patients with CP, CMR can be used as a measure of ongoing inflammation and its presence correlates with disease activity. It can be performed serially in CP patients to follow disease progression and resolution with medical management, thus avoiding unwanted referrals to surgery.