The Experts below are selected from a list of 3162 Experts worldwide ranked by ideXlab platform
Massimo Imazio - One of the best experts on this subject based on the ideXlab platform.
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national trends of Acute Pericarditis post atrial fibrillation ablation
International Journal of Clinical Practice, 2020Co-Authors: Fahed Darmoch, Chadi M Alraies, Yasser Alkhadra, Homam Moussa Pacha, Mohamad Soud, Tarek Chami, Massimo Imazio, Allan L KleinAbstract:BACKGROUND Atrial fibrillation ablation increased over the last two decades by its high success rate. However, the trend of inpatient adverse outcomes is limited. The aim of this study to examine the frequency and predictors of Acute Pericarditis resulting from catheter ablation. METHODS Using the National Inpatient Sample, we identified all patients who underwent AF ablation. Univariate and multivariate logistic regressions were performed for the primary outcome of in-hospital Acute Pericarditis post-AF ablation. Variance-weighted regression has been used to test for linear and curvilinear trends in disease characteristics and outcomes over time. RESULTS From 2002 to 2014, our study included 122,993 patients, Acute Pericarditis was found in 984 (0.8%) patients who underwent AF ablation. The trend of Acute Pericarditis showed inconsistent fluctuation leaning towards reduction over the years. Multivariate analysis showed that patients of female gender are at a 40% higher risk of Acute Pericarditis post-ablation compared with males. Additionally, obese patients have a 40% higher risk of developing Acute Pericarditis compared with patients who have BMI < 30. Furthermore, anaemia and rheumatoid arthritis have the odds ratio (OR: 2.63; 95% [CI] 2.04-3.39) and (OR: 1.64; 95% [CI] 1.08-2.48). CONCLUSION Post-AF ablation, in-hospital Acute Pericarditis showed inconsistent fluctuation leaning towards reduction. Female gender and obesity are at higher risk for developing Acute Pericarditis post-AF ablations. Proper evaluation might alter those complications.
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National trends of Acute Pericarditis post‐atrial fibrillation ablation
International journal of clinical practice, 2019Co-Authors: Fahed Darmoch, Homam Moussa Pacha, Mohamad Soud, Tarek Chami, Massimo Imazio, M. Chadi Alraies, Yasser Al-khadra, Allan L KleinAbstract:BACKGROUND Atrial fibrillation ablation increased over the last two decades by its high success rate. However, the trend of inpatient adverse outcomes is limited. The aim of this study to examine the frequency and predictors of Acute Pericarditis resulting from catheter ablation. METHODS Using the National Inpatient Sample, we identified all patients who underwent AF ablation. Univariate and multivariate logistic regressions were performed for the primary outcome of in-hospital Acute Pericarditis post-AF ablation. Variance-weighted regression has been used to test for linear and curvilinear trends in disease characteristics and outcomes over time. RESULTS From 2002 to 2014, our study included 122,993 patients, Acute Pericarditis was found in 984 (0.8%) patients who underwent AF ablation. The trend of Acute Pericarditis showed inconsistent fluctuation leaning towards reduction over the years. Multivariate analysis showed that patients of female gender are at a 40% higher risk of Acute Pericarditis post-ablation compared with males. Additionally, obese patients have a 40% higher risk of developing Acute Pericarditis compared with patients who have BMI
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Acute Pericarditis: Management Overview
Myopericardial Diseases, 2016Co-Authors: Massimo ImazioAbstract:Acute Pericarditis is the most common pericardial syndrome that is encountered in clinical practice. It is an inflammatory pericardial syndrome with or without pericardial effusion [1, 2].
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incidence and prognostic significance of new onset atrial fibrillation flutter in Acute Pericarditis
Heart, 2015Co-Authors: Massimo Imazio, George Lazaros, Charalambos Vlachopoulos, Panagiotis Vasileiou, Elisa Picardi, Fabrizio Orlando, Mara Carraro, Dimitris Tsiachris, George Georgiopoulos, Dimitrios TousoulisAbstract:Objective Data on the incidence of new onset atrial fibrillation and flutter (AF/f) in patients with Acute Pericarditis are limited. We sought to determine the incidence and prognostic significance of AF/f in this setting. Methods Between January 2006 and June 2014, consecutive new cases of Acute Pericarditis were included in two urban referral centres for pericardial diseases. All new cases of AF/f defined as episodes lasting ≥30 s were recorded. Events considered during follow-up consisted of AF/f and Pericarditis recurrence, cardiac tamponade, pericardial constriction and death. Results 822 consecutive new cases of Acute Pericarditis (mean age 53±15 years, 444 men) were analysed. AF/f was detected in 35 patients (4.3%, mean age 66.5±11.3 years, 18 men). Patients with AF/f were significantly older (p=0.017) and presented more frequently with pericardial effusion (p 24 h in 25.7% and spontaneously converted in 74.3% of patients. Underlying structural heart disease was present in 17% of AF/f cases. In a 30-month follow-up, patients with history of AF/f at the initial episode had a higher rate of arrhythmia occurrence (34.3% vs 0.9%, p Conclusions The occurrence of AF/f in Acute Pericarditis identifies a predisposed population to AF/f with a high recurrence risk (about 35%): in these patients, Pericarditis may act as an arrhythmic trigger and oral anticoagulation should be seriously considered according to guidelines.
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Incidence and prognostic significance of new onset atrial fibrillation/flutter in Acute Pericarditis
Heart (British Cardiac Society), 2015Co-Authors: Massimo Imazio, George Lazaros, Charalambos Vlachopoulos, Panagiotis Vasileiou, Elisa Picardi, Fabrizio Orlando, Mara Carraro, Dimitris Tsiachris, George Georgiopoulos, Dimitrios TousoulisAbstract:Objective Data on the incidence of new onset atrial fibrillation and flutter (AF/f) in patients with Acute Pericarditis are limited. We sought to determine the incidence and prognostic significance of AF/f in this setting. Methods Between January 2006 and June 2014, consecutive new cases of Acute Pericarditis were included in two urban referral centres for pericardial diseases. All new cases of AF/f defined as episodes lasting ≥30 s were recorded. Events considered during follow-up consisted of AF/f and Pericarditis recurrence, cardiac tamponade, pericardial constriction and death. Results 822 consecutive new cases of Acute Pericarditis (mean age 53±15 years, 444 men) were analysed. AF/f was detected in 35 patients (4.3%, mean age 66.5±11.3 years, 18 men). Patients with AF/f were significantly older (p=0.017) and presented more frequently with pericardial effusion (p 24 h in 25.7% and spontaneously converted in 74.3% of patients. Underlying structural heart disease was present in 17% of AF/f cases. In a 30-month follow-up, patients with history of AF/f at the initial episode had a higher rate of arrhythmia occurrence (34.3% vs 0.9%, p Conclusions The occurrence of AF/f in Acute Pericarditis identifies a predisposed population to AF/f with a high recurrence risk (about 35%): in these patients, Pericarditis may act as an arrhythmic trigger and oral anticoagulation should be seriously considered according to guidelines.
Rita Trinchero - One of the best experts on this subject based on the ideXlab platform.
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Colchicine for Acute Pericarditis. Results from the Investigation on Colchicine in Acute Pericarditis (ICAP). A prospective, randomized, double-blind, placebo-controlled, multicenter trial
European Heart Journal, 2013Co-Authors: Massimo Imazio, Antonio Brucato, Riccardo Belli, Rita Trinchero, Roberto Cemin, Stefania Ferrua, Stefano Maggiolini, D. H. Spodick, Yehuda AdlerAbstract:Purpose: Despite a large amount of data on recurrent Pericarditis, conclusive data are lacking to demonstrate the efficacy and safety of colchicine for the treatment of the first attack of Acute Pericarditis. The Investigation on Colchicine in Acute Pericarditis (ICAP) trial is a prospective, randomized, double-blind, placebo-controlled, multicenter trial aimed at the evaluation of the efficacy and safety of colchicine to treat Acute Pericarditis and prevent its recurrences. Methods: Eligible adult patients with Acute Pericarditis were randomly assigned to placebo or colchicine (0.5 mg twice daily for 3 months for patients>70kg or 0.5 mg once daily if ≤70kg) in addition to conventional anti-inflammatory therapy with aspirin or ibuprofen in a multicenter, double-blind, placebo-controlled trial. The primary study outcome was incessant/recurrent Pericarditis within 18 months. Secondary outcomes were symptoms persistence at 72 hours, remission within 1 week, number of recurrences, time to first recurrence, disease-related hospitalization, cardiac tamponade, and constrictive Pericarditis. Results: Of the 240 randomly assigned participants (mean age 52.1±16.9 years, 60% males), 65 patients (27.1%) reached the primary outcome: incessant/recurrent Pericarditis within 18 months was 16.7% in the colchicine group and 37.5% in the placebo group (relative risk reduction 0.56 95% CI 0.30-0.72; number needed to treat-NNT 4). Colchicine reduced symptoms persistence at 72 hours (respectively, 19.2% vs. 40.0%; p=0.001), number of recurrences, hospitalizations (respectively, 5.0% vs. 14.2%; p=0.016), improved the remission rate at 1 week (respectively, 85.0% vs. 58.3%; p
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colchicine for Acute Pericarditis results from the investigation on colchicine in Acute Pericarditis icap a prospective randomized double blind placebo controlled multicenter trial
European Heart Journal, 2013Co-Authors: Massimo Imazio, Antonio Brucato, Riccardo Belli, Rita Trinchero, Roberto Cemin, Stefania Ferrua, Stefano Maggiolini, D. H. Spodick, Yehuda AdlerAbstract:Purpose: Despite a large amount of data on recurrent Pericarditis, conclusive data are lacking to demonstrate the efficacy and safety of colchicine for the treatment of the first attack of Acute Pericarditis. The Investigation on Colchicine in Acute Pericarditis (ICAP) trial is a prospective, randomized, double-blind, placebo-controlled, multicenter trial aimed at the evaluation of the efficacy and safety of colchicine to treat Acute Pericarditis and prevent its recurrences. Methods: Eligible adult patients with Acute Pericarditis were randomly assigned to placebo or colchicine (0.5 mg twice daily for 3 months for patients>70kg or 0.5 mg once daily if ≤70kg) in addition to conventional anti-inflammatory therapy with aspirin or ibuprofen in a multicenter, double-blind, placebo-controlled trial. The primary study outcome was incessant/recurrent Pericarditis within 18 months. Secondary outcomes were symptoms persistence at 72 hours, remission within 1 week, number of recurrences, time to first recurrence, disease-related hospitalization, cardiac tamponade, and constrictive Pericarditis. Results: Of the 240 randomly assigned participants (mean age 52.1±16.9 years, 60% males), 65 patients (27.1%) reached the primary outcome: incessant/recurrent Pericarditis within 18 months was 16.7% in the colchicine group and 37.5% in the placebo group (relative risk reduction 0.56 95% CI 0.30-0.72; number needed to treat-NNT 4). Colchicine reduced symptoms persistence at 72 hours (respectively, 19.2% vs. 40.0%; p=0.001), number of recurrences, hospitalizations (respectively, 5.0% vs. 14.2%; p=0.016), improved the remission rate at 1 week (respectively, 85.0% vs. 58.3%; p<0.001), and prolonged time to first recurrence. Corticosteroid use (OR 4.17, 95% CI 1.28 to 13.53; p=0.018), and C-reactive protein elevation at presentation (OR 3.15, 95% CI 1.05 to 9.49; p=0.041) were independent risk factors for recurrences in multivariable analysis. Overall adverse effect rates were similar in the study groups (respectively, 11.7% in the colchicine group and 10.0% in the placebo group; p=0.836) as well as withdrawal rates (respectively, 11.7% vs. 8.3%; p=0.519). No serious adverse effects were observed. Conclusions: The ICAP trial is the first multicenter, double-blind, randomized trial to show the efficacy and safety of colchicine as an adjunct to conventional anti-inflammatory therapy to halve incessant/recurrent Pericarditis within 18 months, reduce the number of recurrences, and prolong the time to subsequent recurrence after a first episode of Acute Pericarditis. ClinicalTrials.gov [NCT00128453][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00128453&atom=%2Fehj%2F34%2Fsuppl_1%2F877.atom
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Risk of Constrictive Pericarditis After Acute Pericarditis
Circulation, 2011Co-Authors: Massimo Imazio, Antonio Brucato, Silvia Maestroni, Davide Cumetti, Riccardo Belli, Rita Trinchero, Yehuda AdlerAbstract:Background—Constrictive Pericarditis (CP) is considered a rare, dreaded possible complication of Acute Pericarditis. Nevertheless, there is a lack of prospective studies that have evaluated the specific risk according to different etiologies. The aim of this study is to evaluate the risk of CP after Acute Pericarditis in a prospective cohort study with long-term follow-up. Methods and Results—From January 2000 to December 2008, 500 consecutive cases with a first episode of Acute Pericarditis (age, 51±16 years; 270 men) were prospectively studied to evaluate the evolution toward CP. Etiologies were viral/idiopathic in 416 cases (83.2%), connective tissue disease/pericardial injury syndromes in 36 cases (7.2%), neoplastic Pericarditis in 25 cases (5.0%), tuberculosis in 20 cases (4.0%), and purulent in 3 cases (0.6%). During a median follow-up of 72 months (range, 24 to 120 months), CP developed in 9 of 500 patients (1.8%): 2 of 416 patients with idiopathic/viral Pericarditis (0.48%) versus 7 of 84 patients...
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MyoPericarditis versus viral or idiopathic Acute Pericarditis
Heart (British Cardiac Society), 2007Co-Authors: Massimo Imazio, Riccardo Belli, Enrico Cecchi, Brunella Demichelis, Salvatore Ierna, Daniela Demarie, Aldo Ghisio, Pomari F, Alessandra Chinaglia, Rita TrincheroAbstract:Objective: To investigate the relative incidence, clinical presentation and prognosis of myoPericarditis among patients with idiopathic or viral Acute Pericarditis. Design: Prospective observational clinical cohort study. Setting: Two general hospitals from an urban area of 220 000 inhabitants. Patients: 274 consecutive cases of idiopathic or viral Acute Pericarditis between January 2001 and June 2005. Main outcome measures: Relative prevalence of myoPericarditis. Clinical features at presentation including echocardiographic data (ejection fraction (EF), wall motion score index (WMSI)) and follow-up data at 12 months including complications, results of echocardiography, electrocardiography and treadmill testing. Results: MyoPericarditis was recorded in 40/274 (14.6%) consecutive patients. At presentation, the following clinical features were independently associated with myoPericarditis: arrhythmias (odds ratio (OR) = 17.6, 95% confidence interval (CI) 5.7 to 54.1; p Conclusions: MyoPericarditis is relatively common and shows a benign evolution also in spontaneous cases not related to vaccination.
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Indicators of Poor Prognosis of Acute Pericarditis
Circulation, 2007Co-Authors: Massimo Imazio, Riccardo Belli, Enrico Cecchi, Brunella Demichelis, Salvatore Ierna, Daniela Demarie, Aldo Ghisio, Pomari F, Luisella Coda, Rita TrincheroAbstract:Background— The clinical search for indicators of poor prognosis of Acute Pericarditis may be useful for clinical triage of patients at high risk of specific causal conditions or complications. The...
Yehuda Adler - One of the best experts on this subject based on the ideXlab platform.
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Colchicine for Acute Pericarditis. Results from the Investigation on Colchicine in Acute Pericarditis (ICAP). A prospective, randomized, double-blind, placebo-controlled, multicenter trial
European Heart Journal, 2013Co-Authors: Massimo Imazio, Antonio Brucato, Riccardo Belli, Rita Trinchero, Roberto Cemin, Stefania Ferrua, Stefano Maggiolini, D. H. Spodick, Yehuda AdlerAbstract:Purpose: Despite a large amount of data on recurrent Pericarditis, conclusive data are lacking to demonstrate the efficacy and safety of colchicine for the treatment of the first attack of Acute Pericarditis. The Investigation on Colchicine in Acute Pericarditis (ICAP) trial is a prospective, randomized, double-blind, placebo-controlled, multicenter trial aimed at the evaluation of the efficacy and safety of colchicine to treat Acute Pericarditis and prevent its recurrences. Methods: Eligible adult patients with Acute Pericarditis were randomly assigned to placebo or colchicine (0.5 mg twice daily for 3 months for patients>70kg or 0.5 mg once daily if ≤70kg) in addition to conventional anti-inflammatory therapy with aspirin or ibuprofen in a multicenter, double-blind, placebo-controlled trial. The primary study outcome was incessant/recurrent Pericarditis within 18 months. Secondary outcomes were symptoms persistence at 72 hours, remission within 1 week, number of recurrences, time to first recurrence, disease-related hospitalization, cardiac tamponade, and constrictive Pericarditis. Results: Of the 240 randomly assigned participants (mean age 52.1±16.9 years, 60% males), 65 patients (27.1%) reached the primary outcome: incessant/recurrent Pericarditis within 18 months was 16.7% in the colchicine group and 37.5% in the placebo group (relative risk reduction 0.56 95% CI 0.30-0.72; number needed to treat-NNT 4). Colchicine reduced symptoms persistence at 72 hours (respectively, 19.2% vs. 40.0%; p=0.001), number of recurrences, hospitalizations (respectively, 5.0% vs. 14.2%; p=0.016), improved the remission rate at 1 week (respectively, 85.0% vs. 58.3%; p
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colchicine for Acute Pericarditis results from the investigation on colchicine in Acute Pericarditis icap a prospective randomized double blind placebo controlled multicenter trial
European Heart Journal, 2013Co-Authors: Massimo Imazio, Antonio Brucato, Riccardo Belli, Rita Trinchero, Roberto Cemin, Stefania Ferrua, Stefano Maggiolini, D. H. Spodick, Yehuda AdlerAbstract:Purpose: Despite a large amount of data on recurrent Pericarditis, conclusive data are lacking to demonstrate the efficacy and safety of colchicine for the treatment of the first attack of Acute Pericarditis. The Investigation on Colchicine in Acute Pericarditis (ICAP) trial is a prospective, randomized, double-blind, placebo-controlled, multicenter trial aimed at the evaluation of the efficacy and safety of colchicine to treat Acute Pericarditis and prevent its recurrences. Methods: Eligible adult patients with Acute Pericarditis were randomly assigned to placebo or colchicine (0.5 mg twice daily for 3 months for patients>70kg or 0.5 mg once daily if ≤70kg) in addition to conventional anti-inflammatory therapy with aspirin or ibuprofen in a multicenter, double-blind, placebo-controlled trial. The primary study outcome was incessant/recurrent Pericarditis within 18 months. Secondary outcomes were symptoms persistence at 72 hours, remission within 1 week, number of recurrences, time to first recurrence, disease-related hospitalization, cardiac tamponade, and constrictive Pericarditis. Results: Of the 240 randomly assigned participants (mean age 52.1±16.9 years, 60% males), 65 patients (27.1%) reached the primary outcome: incessant/recurrent Pericarditis within 18 months was 16.7% in the colchicine group and 37.5% in the placebo group (relative risk reduction 0.56 95% CI 0.30-0.72; number needed to treat-NNT 4). Colchicine reduced symptoms persistence at 72 hours (respectively, 19.2% vs. 40.0%; p=0.001), number of recurrences, hospitalizations (respectively, 5.0% vs. 14.2%; p=0.016), improved the remission rate at 1 week (respectively, 85.0% vs. 58.3%; p<0.001), and prolonged time to first recurrence. Corticosteroid use (OR 4.17, 95% CI 1.28 to 13.53; p=0.018), and C-reactive protein elevation at presentation (OR 3.15, 95% CI 1.05 to 9.49; p=0.041) were independent risk factors for recurrences in multivariable analysis. Overall adverse effect rates were similar in the study groups (respectively, 11.7% in the colchicine group and 10.0% in the placebo group; p=0.836) as well as withdrawal rates (respectively, 11.7% vs. 8.3%; p=0.519). No serious adverse effects were observed. Conclusions: The ICAP trial is the first multicenter, double-blind, randomized trial to show the efficacy and safety of colchicine as an adjunct to conventional anti-inflammatory therapy to halve incessant/recurrent Pericarditis within 18 months, reduce the number of recurrences, and prolong the time to subsequent recurrence after a first episode of Acute Pericarditis. ClinicalTrials.gov [NCT00128453][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00128453&atom=%2Fehj%2F34%2Fsuppl_1%2F877.atom
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Risk of Constrictive Pericarditis After Acute Pericarditis
Circulation, 2011Co-Authors: Massimo Imazio, Antonio Brucato, Silvia Maestroni, Davide Cumetti, Riccardo Belli, Rita Trinchero, Yehuda AdlerAbstract:Background—Constrictive Pericarditis (CP) is considered a rare, dreaded possible complication of Acute Pericarditis. Nevertheless, there is a lack of prospective studies that have evaluated the specific risk according to different etiologies. The aim of this study is to evaluate the risk of CP after Acute Pericarditis in a prospective cohort study with long-term follow-up. Methods and Results—From January 2000 to December 2008, 500 consecutive cases with a first episode of Acute Pericarditis (age, 51±16 years; 270 men) were prospectively studied to evaluate the evolution toward CP. Etiologies were viral/idiopathic in 416 cases (83.2%), connective tissue disease/pericardial injury syndromes in 36 cases (7.2%), neoplastic Pericarditis in 25 cases (5.0%), tuberculosis in 20 cases (4.0%), and purulent in 3 cases (0.6%). During a median follow-up of 72 months (range, 24 to 120 months), CP developed in 9 of 500 patients (1.8%): 2 of 416 patients with idiopathic/viral Pericarditis (0.48%) versus 7 of 84 patients...
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Colchicine for recurrent Acute Pericarditis.
Archives of internal medicine, 2006Co-Authors: Antonio Brucato, Yehuda Adler, G. Brambilla, David H. SpodickAbstract:W e congratulate Imazio et al 1 for their excellent article on colchicine treatment for recurrent Pericarditis. We also strongly agree that colchicine is useful for this condition, even in difficult patients. We have also used the half dose of 0.5 mg, in some conditions, to improve compliance. On the other hand, in clinical practice many physicians do not believe colchicine works, perhaps because they still see recurrences after starting treatment with this drug. In our opinion, there are several explanations for this. First, colchicine is clearly useful for Acute Pericarditis but not for other types of pericardial diseases that are often erroneously labeled as “Pericarditis”; for instance, it is not useful for painless chronic pericardial effusions with a normal C-reactive protein level. Second, some physicians discontinue treatment with corticosteroids and nonsteroidal anti-inflammatory drugs and add de novo colchicine, but treatment with only colchicine will probably lead to another failure. Finally, in complicated patients with a long history of recurrences at each corticosteroid withdrawal, adding colchicine treatment will give a good chance of controlling the disease only if the corticosteroid is tapered extremely slowly over months; in these difficult corticosteroid-dependent patients it is crucial to switch from rapid steroid-tapering to very gradual tapering to obtain a good control of the disease. Even if colchicine is not a magic bullet that alone will cure all the pericardial diseases and all the most complicated cases of recurrent Acute Pericarditis, the important article by Imazio et al should convince even the more skeptical cardiologists that colchicine really works when used correctly in the proper setting.
Riccardo Belli - One of the best experts on this subject based on the ideXlab platform.
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Colchicine for Acute Pericarditis. Results from the Investigation on Colchicine in Acute Pericarditis (ICAP). A prospective, randomized, double-blind, placebo-controlled, multicenter trial
European Heart Journal, 2013Co-Authors: Massimo Imazio, Antonio Brucato, Riccardo Belli, Rita Trinchero, Roberto Cemin, Stefania Ferrua, Stefano Maggiolini, D. H. Spodick, Yehuda AdlerAbstract:Purpose: Despite a large amount of data on recurrent Pericarditis, conclusive data are lacking to demonstrate the efficacy and safety of colchicine for the treatment of the first attack of Acute Pericarditis. The Investigation on Colchicine in Acute Pericarditis (ICAP) trial is a prospective, randomized, double-blind, placebo-controlled, multicenter trial aimed at the evaluation of the efficacy and safety of colchicine to treat Acute Pericarditis and prevent its recurrences. Methods: Eligible adult patients with Acute Pericarditis were randomly assigned to placebo or colchicine (0.5 mg twice daily for 3 months for patients>70kg or 0.5 mg once daily if ≤70kg) in addition to conventional anti-inflammatory therapy with aspirin or ibuprofen in a multicenter, double-blind, placebo-controlled trial. The primary study outcome was incessant/recurrent Pericarditis within 18 months. Secondary outcomes were symptoms persistence at 72 hours, remission within 1 week, number of recurrences, time to first recurrence, disease-related hospitalization, cardiac tamponade, and constrictive Pericarditis. Results: Of the 240 randomly assigned participants (mean age 52.1±16.9 years, 60% males), 65 patients (27.1%) reached the primary outcome: incessant/recurrent Pericarditis within 18 months was 16.7% in the colchicine group and 37.5% in the placebo group (relative risk reduction 0.56 95% CI 0.30-0.72; number needed to treat-NNT 4). Colchicine reduced symptoms persistence at 72 hours (respectively, 19.2% vs. 40.0%; p=0.001), number of recurrences, hospitalizations (respectively, 5.0% vs. 14.2%; p=0.016), improved the remission rate at 1 week (respectively, 85.0% vs. 58.3%; p
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colchicine for Acute Pericarditis results from the investigation on colchicine in Acute Pericarditis icap a prospective randomized double blind placebo controlled multicenter trial
European Heart Journal, 2013Co-Authors: Massimo Imazio, Antonio Brucato, Riccardo Belli, Rita Trinchero, Roberto Cemin, Stefania Ferrua, Stefano Maggiolini, D. H. Spodick, Yehuda AdlerAbstract:Purpose: Despite a large amount of data on recurrent Pericarditis, conclusive data are lacking to demonstrate the efficacy and safety of colchicine for the treatment of the first attack of Acute Pericarditis. The Investigation on Colchicine in Acute Pericarditis (ICAP) trial is a prospective, randomized, double-blind, placebo-controlled, multicenter trial aimed at the evaluation of the efficacy and safety of colchicine to treat Acute Pericarditis and prevent its recurrences. Methods: Eligible adult patients with Acute Pericarditis were randomly assigned to placebo or colchicine (0.5 mg twice daily for 3 months for patients>70kg or 0.5 mg once daily if ≤70kg) in addition to conventional anti-inflammatory therapy with aspirin or ibuprofen in a multicenter, double-blind, placebo-controlled trial. The primary study outcome was incessant/recurrent Pericarditis within 18 months. Secondary outcomes were symptoms persistence at 72 hours, remission within 1 week, number of recurrences, time to first recurrence, disease-related hospitalization, cardiac tamponade, and constrictive Pericarditis. Results: Of the 240 randomly assigned participants (mean age 52.1±16.9 years, 60% males), 65 patients (27.1%) reached the primary outcome: incessant/recurrent Pericarditis within 18 months was 16.7% in the colchicine group and 37.5% in the placebo group (relative risk reduction 0.56 95% CI 0.30-0.72; number needed to treat-NNT 4). Colchicine reduced symptoms persistence at 72 hours (respectively, 19.2% vs. 40.0%; p=0.001), number of recurrences, hospitalizations (respectively, 5.0% vs. 14.2%; p=0.016), improved the remission rate at 1 week (respectively, 85.0% vs. 58.3%; p<0.001), and prolonged time to first recurrence. Corticosteroid use (OR 4.17, 95% CI 1.28 to 13.53; p=0.018), and C-reactive protein elevation at presentation (OR 3.15, 95% CI 1.05 to 9.49; p=0.041) were independent risk factors for recurrences in multivariable analysis. Overall adverse effect rates were similar in the study groups (respectively, 11.7% in the colchicine group and 10.0% in the placebo group; p=0.836) as well as withdrawal rates (respectively, 11.7% vs. 8.3%; p=0.519). No serious adverse effects were observed. Conclusions: The ICAP trial is the first multicenter, double-blind, randomized trial to show the efficacy and safety of colchicine as an adjunct to conventional anti-inflammatory therapy to halve incessant/recurrent Pericarditis within 18 months, reduce the number of recurrences, and prolong the time to subsequent recurrence after a first episode of Acute Pericarditis. ClinicalTrials.gov [NCT00128453][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00128453&atom=%2Fehj%2F34%2Fsuppl_1%2F877.atom
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Risk of Constrictive Pericarditis After Acute Pericarditis
Circulation, 2011Co-Authors: Massimo Imazio, Antonio Brucato, Silvia Maestroni, Davide Cumetti, Riccardo Belli, Rita Trinchero, Yehuda AdlerAbstract:Background—Constrictive Pericarditis (CP) is considered a rare, dreaded possible complication of Acute Pericarditis. Nevertheless, there is a lack of prospective studies that have evaluated the specific risk according to different etiologies. The aim of this study is to evaluate the risk of CP after Acute Pericarditis in a prospective cohort study with long-term follow-up. Methods and Results—From January 2000 to December 2008, 500 consecutive cases with a first episode of Acute Pericarditis (age, 51±16 years; 270 men) were prospectively studied to evaluate the evolution toward CP. Etiologies were viral/idiopathic in 416 cases (83.2%), connective tissue disease/pericardial injury syndromes in 36 cases (7.2%), neoplastic Pericarditis in 25 cases (5.0%), tuberculosis in 20 cases (4.0%), and purulent in 3 cases (0.6%). During a median follow-up of 72 months (range, 24 to 120 months), CP developed in 9 of 500 patients (1.8%): 2 of 416 patients with idiopathic/viral Pericarditis (0.48%) versus 7 of 84 patients...
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MyoPericarditis versus viral or idiopathic Acute Pericarditis
Heart (British Cardiac Society), 2007Co-Authors: Massimo Imazio, Riccardo Belli, Enrico Cecchi, Brunella Demichelis, Salvatore Ierna, Daniela Demarie, Aldo Ghisio, Pomari F, Alessandra Chinaglia, Rita TrincheroAbstract:Objective: To investigate the relative incidence, clinical presentation and prognosis of myoPericarditis among patients with idiopathic or viral Acute Pericarditis. Design: Prospective observational clinical cohort study. Setting: Two general hospitals from an urban area of 220 000 inhabitants. Patients: 274 consecutive cases of idiopathic or viral Acute Pericarditis between January 2001 and June 2005. Main outcome measures: Relative prevalence of myoPericarditis. Clinical features at presentation including echocardiographic data (ejection fraction (EF), wall motion score index (WMSI)) and follow-up data at 12 months including complications, results of echocardiography, electrocardiography and treadmill testing. Results: MyoPericarditis was recorded in 40/274 (14.6%) consecutive patients. At presentation, the following clinical features were independently associated with myoPericarditis: arrhythmias (odds ratio (OR) = 17.6, 95% confidence interval (CI) 5.7 to 54.1; p Conclusions: MyoPericarditis is relatively common and shows a benign evolution also in spontaneous cases not related to vaccination.
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Indicators of Poor Prognosis of Acute Pericarditis
Circulation, 2007Co-Authors: Massimo Imazio, Riccardo Belli, Enrico Cecchi, Brunella Demichelis, Salvatore Ierna, Daniela Demarie, Aldo Ghisio, Pomari F, Luisella Coda, Rita TrincheroAbstract:Background— The clinical search for indicators of poor prognosis of Acute Pericarditis may be useful for clinical triage of patients at high risk of specific causal conditions or complications. The...
P. Touboul - One of the best experts on this subject based on the ideXlab platform.
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Serum cardiac troponin I and ST-segment elevation in patients with Acute Pericarditis.
European heart journal, 2000Co-Authors: Eric Bonnefoy, P. Godon, Gilbert Kirkorian, M. Fatemi, Philippe Chevalier, P. TouboulAbstract:Objective ST-segment elevation in Acute Pericarditis is believed to be caused by superficial myocardial inflammation or epicardial injury. We used cardiac troponin I, a sensitive and specific marker of myocardial injury, to assess myocardial lesions in idiopathic Acute Pericarditis and its relationship to ST-segment elevation. Patients and Methods Sixty-nine consecutive patients (53 men, 48±17 years) with idiopathic Acute Pericarditis were included. We used an enzymoimmunoflurometric method to measure serum cardiac troponin I on admission (myocardial infarction threshold was 1·5ng.ml−1). Results Cardiac troponin I was detectable in 34 patients (49%) and was beyond the 1·5ng.ml−1threshold in 15 (22%). Coronary angiography performed in seven of these 15 patients was normal in all of them. ST-segment elevation was observed in 93% of the patients with cardiac troponin I >1·5ng.ml−1vs 57% of those without ( P
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serum cardiac troponin i and st segment elevation in patients with Acute Pericarditis
European Heart Journal, 2000Co-Authors: Eric Bonnefoy, P. Godon, Gilbert Kirkorian, M. Fatemi, Philippe Chevalier, P. TouboulAbstract:Objective ST-segment elevation in Acute Pericarditis is believed to be caused by superficial myocardial inflammation or epicardial injury. We used cardiac troponin I, a sensitive and specific marker of myocardial injury, to assess myocardial lesions in idiopathic Acute Pericarditis and its relationship to ST-segment elevation. Patients and Methods Sixty-nine consecutive patients (53 men, 48±17 years) with idiopathic Acute Pericarditis were included. We used an enzymoimmunoflurometric method to measure serum cardiac troponin I on admission (myocardial infarction threshold was 1·5ng.ml−1). Results Cardiac troponin I was detectable in 34 patients (49%) and was beyond the 1·5ng.ml−1threshold in 15 (22%). Coronary angiography performed in seven of these 15 patients was normal in all of them. ST-segment elevation was observed in 93% of the patients with cardiac troponin I >1·5ng.ml−1vs 57% of those without ( P <0·01). Sensitivity of ST-segment elevation to detect myocardial injury was 93% and specificity 43%. Patients with a cardiac troponin I increase higher than 1·5ng.ml−1were more likely to have had a recent infection (66% vs 31%; P =0·01) and were younger (37±14 vs 52±16 years; P =0·002). There was no significant relationship with other parameters such as pericardial friction rub, fever, PR segment abnormalities, echocardiographic findings or C-reactive protein. Conclusion In patients with idiopathic Acute Pericarditis, an increase in cardiac troponin I is frequently observed, especially in younger patients and those with a recent infection. Although ST-segment elevation does not reliably indicate myocardial injury, a significant cardiac troponin I increase is only seen in these patients.