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Massimo Imazio - One of the best experts on this subject based on the ideXlab platform.
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Recurrent Pericarditis: an update on diagnosis and management
Internal and Emergency Medicine, 2021Co-Authors: Alessandro Andreis, Massimo Imazio, Matteo Casula, Stefano Avondo, Antonio BrucatoAbstract:Recurrent Pericarditis is a true challenge for clinicians, especially when the patient becomes unresponsive or not tolerant to conventional treatments. An accurate diagnosis of recurrent Pericarditis, possibly supported by advanced imaging tools, is critical to provide timely and appropriate treatment of symptoms and prevention of further episodes. The incessant research on the inflammatory pathways underlying cardiovascular diseases, led recently to the assessment of anti interleukin-1 agents in the setting of recurrent Pericarditis. This review will focus on the diagnostic assessment of recurrent Pericarditis, along with the most modern therapeutic advances in this field. Bibliographic databases were searched (MEDLINE/PubMed, BioMed Central, the Cochrane Collaboration Database of Randomized Trials, Scopus, ClinicalTrials.gov, EMBASE, Google Scholar) using the terms “recurrent Pericarditis” AND “diagnosis” OR “treatment” OR “IL-1” OR “inflammation”.
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trends in acute Pericarditis hospitalizations and outcomes among the elderly in the usa 1999 2012
European Heart Journal - Quality of Care and Clinical Outcomes, 2018Co-Authors: Purav Mody, Massimo Imazio, Yun Wang, Behnood Bikdeli, Harlan M KrumholzAbstract:Aims The elderly are at risk of Pericarditis from conditions such as malignancy, renal disease, and after cardiac surgery. However, the burden of Pericarditis and, especially, the long-term outcomes associated with Pericarditis have not been described before among the elderly. Methods and results We examined hospitalization rates; in-hospital, 30-day, and 1-year all-cause mortality rates; all-cause 30-day readmission rates; length of stay and health care expenditure for Medicare beneficiaries aged 65 years or older with a principal discharge diagnosis of Pericarditis from 1999 to 2012. A total of 45 504 hospitalizations were identified. The hospitalization rate for Pericarditis remained stable at 26 per 100 000 person-years across the study period and was consistently higher among men and the oldest old. The adjusted all-cause 30-day mortality rates decreased from 7.6% [95% confidence interval (CI) 6.9-8.2] in 1999 to 5.7% (95% CI 4.5-7.1) in 2012 and all-cause 1-year mortality rates decreased from 19.7% (95% CI 18.8-20.8) in 1999 to 17.3% (95% CI 15.3-20) in 2011 respectively. The 30-day all-cause readmission rate remained unchanged at 18% across the study period. The length of stay ranged from a mean of 5.8 days in 1999 to 5.5 days in 2012. The consumer price index adjusted cost per hospitalization increased from $8404 in 1999 to $9982 in 2012. Conclusion The hospitalization rate for acute Pericarditis has remained unchanged among older adults. Although mortality rates associated with Pericarditis have improved, hospitalization for Pericarditis continues to signal a high risk of dying within a year.
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Acute and Recurrent Pericarditis.
Cardiology clinics, 2017Co-Authors: Massimo Imazio, Fiorenzo GaitaAbstract:Acute and recurrent Pericarditis are the most common disorders involving the pericardium. There are few available epidemiological data and the exact incidence and prevalence of acute and recurrent Pericarditis are unknown. However, acute Pericarditis is recorded in about 0.1 % of hospitalized patients and 5 % of patients admitted to the Emergency Department for non-ischemic chest pain [1, 2]. In an observational study from an urban area in Northern Italy the incidence of acute Pericarditis was 27.7 cases per 100,000 persons per year [3].
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effect of anakinra on recurrent Pericarditis among patients with colchicine resistance and corticosteroid dependence the airtrip randomized clinical trial
JAMA, 2016Co-Authors: Antonio Brucato, Massimo Imazio, Silvia Maestroni, Davide Cumetti, Marco Gattorno, George Lazaros, Mara Carraro, Martina Finetti, Alessandra Carobbio, Nicolino RupertoAbstract:Importance Anakinra, an interleukin 1β recombinant receptor antagonist, may have potential to treat colchicine-resistant and corticosteroid-dependent recurrent Pericarditis. Objective To determine the efficacy of anakinra for colchicine-resistant and corticosteroid-dependent recurrent Pericarditis. Design, Setting, and Participants The Anakinra—Treatment of Recurrent Idiopathic Pericarditis (AIRTRIP) double-blind, placebo-controlled, randomized withdrawal trial (open label with anakinra followed by a double-blind withdrawal step with anakinra or placebo until recurrent Pericarditis occurred) conducted among 21 consecutive patients enrolled at 3 Italian referral centers between June and November 2014 (end of follow-up, October 2015). Included patients had recurrent Pericarditis (with ≥3 previous recurrences), elevation of C-reactive protein, colchicine resistance, and corticosteroid dependence. Interventions Anakinra was administered at 2 mg/kg per day, up to 100 mg, for 2 months, then patients who responded with resolution of Pericarditis were randomized to continue anakinra (n = 11) or switch to placebo (n = 10) for 6 months or until a Pericarditis recurrence. Main Outcomes and Measures The primary outcomes were recurrent Pericarditis and time to recurrence after randomization. Results Eleven patients (7 female) randomized to anakinra had a mean age of 46.5 (SD, 16.3) years; 10 patients (7 female) randomized to placebo had a mean age of 44 (SD, 12.5) years. All patients were followed up for 12 months. Median follow-up was 14 (range, 12-17) months. Recurrent Pericarditis occurred in 9 of 10 patients (90%; incidence rate, 2.06% of patients per year) assigned to placebo and 2 of 11 patients (18.2%; incidence rate, 0.11% of patients per year) assigned to anakinra, for an incidence rate difference of −1.95% (95% CI, −3.3% to −0.6%). Median flare-free survival (time to flare) was 72 (interquartile range, 64-150) days after randomization in the placebo group and was not reached in the anakinra group ( P Conclusion and Relevance In this preliminary study of patients with recurrent Pericarditis with colchicine resistance and corticosteroid dependence, the use of anakinra compared with placebo reduced the risk of recurrence over a median of 14 months. Larger studies are needed to replicate these findings as well as to assess safety and longer-term efficacy. Trial Registration clinicaltrials.gov Identifier:NCT02219828
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recurrent Pericarditis new and emerging therapeutic options
Nature Reviews Cardiology, 2016Co-Authors: Massimo Imazio, Antonio Brucato, George Lazaros, Fiorenzo GaitaAbstract:Recurrent Pericarditis is one of the most common and troublesome complications after an episode of Pericarditis, and affects 20-50% of patients treated for Pericarditis. In most of these patients, the Pericarditis remains idiopathic, although an immune-mediated (either autoimmune or autoinflammatory) pathogenesis is often presumed. The mainstay of therapy for recurrences is aspirin or NSAIDs, with the adjunct of colchicine. Corticosteroids are a second-line option to be considered for specific indications, such as connective tissue disease or pregnancy; contraindications or intolerance to aspirin, NSAIDs, and/or colchicine; or insufficient response to these medications. Furthermore, corticosteroids can be added to NSAIDs and colchicine in patients with persistent symptoms. In patients who do not respond adequately to any of these conventional therapies, alternative treatment options include azathioprine, intravenous human immunoglobulins, and anakinra. An improved understanding of how recurrent Pericarditis develops after an initiating event is critical to prevent this complication, and further research is needed into the pathogenesis of recurrences. We discuss the aetiology and diagnosis of recurrent Pericarditis, and extensively review the treatment options for this condition.
Antonio Brucato - One of the best experts on this subject based on the ideXlab platform.
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Recurrent Pericarditis: an update on diagnosis and management
Internal and Emergency Medicine, 2021Co-Authors: Alessandro Andreis, Massimo Imazio, Matteo Casula, Stefano Avondo, Antonio BrucatoAbstract:Recurrent Pericarditis is a true challenge for clinicians, especially when the patient becomes unresponsive or not tolerant to conventional treatments. An accurate diagnosis of recurrent Pericarditis, possibly supported by advanced imaging tools, is critical to provide timely and appropriate treatment of symptoms and prevention of further episodes. The incessant research on the inflammatory pathways underlying cardiovascular diseases, led recently to the assessment of anti interleukin-1 agents in the setting of recurrent Pericarditis. This review will focus on the diagnostic assessment of recurrent Pericarditis, along with the most modern therapeutic advances in this field. Bibliographic databases were searched (MEDLINE/PubMed, BioMed Central, the Cochrane Collaboration Database of Randomized Trials, Scopus, ClinicalTrials.gov, EMBASE, Google Scholar) using the terms “recurrent Pericarditis” AND “diagnosis” OR “treatment” OR “IL-1” OR “inflammation”.
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management of acute and recurrent Pericarditis jacc state of the art review
Journal of the American College of Cardiology, 2020Co-Authors: Juan G Chiabrando, Aldo Bonaventura, Alessandra Vecchie, George F Wohlford, Adolfo G Mauro, Jennifer H Jordan, John D Grizzard, Fabrizio Montecucco, Daniel Berrocal, Antonio BrucatoAbstract:Highlights •Pericarditis is the most common disease of the pericardium. Generally self-limiting, Pericarditis can be fraught by a significant risk of acute complications and of recurrences. •Prompt diagnosis and appropriate treatment of acute Pericarditis may reduce the risk of acute complications and recurrences. •New therapies, such as IL-1 blockers, show promising results in patients with recurrent/refractory Pericarditis. •Future studies are needed to deepen the knowledge about Pericarditis pathophysiology and provide targeted therapies.
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Management of Pericarditis
Italian Journal of Medicine, 2019Co-Authors: Ombretta Para, Eleonora Blasi, Martina Finocchi, Tiziana Ciarambino, Chiara Florenzi, Davide Carrara, Elisabetta Benetti, Mariella Frualdo, Antonio BrucatoAbstract:Pericarditis is an inflammatory syndrome involving pericardium, which is a double-walled sac consisting of two leaves, a serous visceral layer in contact with the myocardium (pericardium) and a parietal fibrous one, delimiting a cavity (pericardial cavity) containing pericardial fluid. Pericarditis may occur isolated or as a manifestation of a systemic disorder. Diagnosis and correct management of Pericarditis can be difficult and its natural history is often characterized by a lot of relapses. Treatment of acute Pericarditis should target the underlying etiology. The diagnosis is based on characteristic clinical findings, electrocardiogram, and echocardiography. The goals of treatment are relief of pain, resolution of inflammation (and, if present, pericardial effusion), and prevention of recurrence. Despite a significant impairment of the quality of life, Pericarditis usually has good long-term outcomes.
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effect of anakinra on recurrent Pericarditis among patients with colchicine resistance and corticosteroid dependence the airtrip randomized clinical trial
JAMA, 2016Co-Authors: Antonio Brucato, Massimo Imazio, Silvia Maestroni, Davide Cumetti, Marco Gattorno, George Lazaros, Mara Carraro, Martina Finetti, Alessandra Carobbio, Nicolino RupertoAbstract:Importance Anakinra, an interleukin 1β recombinant receptor antagonist, may have potential to treat colchicine-resistant and corticosteroid-dependent recurrent Pericarditis. Objective To determine the efficacy of anakinra for colchicine-resistant and corticosteroid-dependent recurrent Pericarditis. Design, Setting, and Participants The Anakinra—Treatment of Recurrent Idiopathic Pericarditis (AIRTRIP) double-blind, placebo-controlled, randomized withdrawal trial (open label with anakinra followed by a double-blind withdrawal step with anakinra or placebo until recurrent Pericarditis occurred) conducted among 21 consecutive patients enrolled at 3 Italian referral centers between June and November 2014 (end of follow-up, October 2015). Included patients had recurrent Pericarditis (with ≥3 previous recurrences), elevation of C-reactive protein, colchicine resistance, and corticosteroid dependence. Interventions Anakinra was administered at 2 mg/kg per day, up to 100 mg, for 2 months, then patients who responded with resolution of Pericarditis were randomized to continue anakinra (n = 11) or switch to placebo (n = 10) for 6 months or until a Pericarditis recurrence. Main Outcomes and Measures The primary outcomes were recurrent Pericarditis and time to recurrence after randomization. Results Eleven patients (7 female) randomized to anakinra had a mean age of 46.5 (SD, 16.3) years; 10 patients (7 female) randomized to placebo had a mean age of 44 (SD, 12.5) years. All patients were followed up for 12 months. Median follow-up was 14 (range, 12-17) months. Recurrent Pericarditis occurred in 9 of 10 patients (90%; incidence rate, 2.06% of patients per year) assigned to placebo and 2 of 11 patients (18.2%; incidence rate, 0.11% of patients per year) assigned to anakinra, for an incidence rate difference of −1.95% (95% CI, −3.3% to −0.6%). Median flare-free survival (time to flare) was 72 (interquartile range, 64-150) days after randomization in the placebo group and was not reached in the anakinra group ( P Conclusion and Relevance In this preliminary study of patients with recurrent Pericarditis with colchicine resistance and corticosteroid dependence, the use of anakinra compared with placebo reduced the risk of recurrence over a median of 14 months. Larger studies are needed to replicate these findings as well as to assess safety and longer-term efficacy. Trial Registration clinicaltrials.gov Identifier:NCT02219828
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recurrent Pericarditis new and emerging therapeutic options
Nature Reviews Cardiology, 2016Co-Authors: Massimo Imazio, Antonio Brucato, George Lazaros, Fiorenzo GaitaAbstract:Recurrent Pericarditis is one of the most common and troublesome complications after an episode of Pericarditis, and affects 20-50% of patients treated for Pericarditis. In most of these patients, the Pericarditis remains idiopathic, although an immune-mediated (either autoimmune or autoinflammatory) pathogenesis is often presumed. The mainstay of therapy for recurrences is aspirin or NSAIDs, with the adjunct of colchicine. Corticosteroids are a second-line option to be considered for specific indications, such as connective tissue disease or pregnancy; contraindications or intolerance to aspirin, NSAIDs, and/or colchicine; or insufficient response to these medications. Furthermore, corticosteroids can be added to NSAIDs and colchicine in patients with persistent symptoms. In patients who do not respond adequately to any of these conventional therapies, alternative treatment options include azathioprine, intravenous human immunoglobulins, and anakinra. An improved understanding of how recurrent Pericarditis develops after an initiating event is critical to prevent this complication, and further research is needed into the pathogenesis of recurrences. We discuss the aetiology and diagnosis of recurrent Pericarditis, and extensively review the treatment options for this condition.
Rita Trinchero - One of the best experts on this subject based on the ideXlab platform.
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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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Medical therapy of pericardial diseases: part II: Noninfectious Pericarditis, pericardial effusion and constrictive Pericarditis.
Journal of cardiovascular medicine (Hagerstown Md.), 2010Co-Authors: Massimo Imazio, David H Spodick, Antonio Brucato, Rita Trinchero, Bongani M Mayosi, Francesco Giuseppe Derosa, Chiara Lestuzzi, Antonio Macor, Yehuda AdlerAbstract:The treatment of pericardial diseases is largely empirical because of the relative lack of randomized trials compared with other cardiovascular diseases. The main forms of pericardial diseases that can be encountered in the clinical setting include acute and recurrent Pericarditis, pericardial effusion with or without cardiac tamponade, and constrictive Pericarditis. Medical treatment should be targeted at the cause as much as possible. In this article, the therapy of more common forms of noninfectious Pericarditis (Pericarditis in systemic autoimmune diseases and neoplastic pericardial disease), pericardial effusion, and constrictive Pericarditis is reviewed.
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MyoPericarditis: Etiology, management, and prognosis
International journal of cardiology, 2008Co-Authors: Massimo Imazio, Rita TrincheroAbstract:Acute Pericarditis is often accompanied by some degree of myocarditis. In clinical practice both Pericarditis and myocarditis coexist because they share common etiologic agents, mainly cardiotropic viruses. The term "myoPericarditis" indicates a primarily "pericarditic syndrome" and it is responsible for the majority of cases. The clinical presentation is varied, reflecting the variability of myocardial involvement, that may be focal or diffuse, affecting any or all cardiac chambers. Probably many cases may be subclinical and subtle cardiac symptoms and signs may be overshadowed by the systemic manifestations of the viral infection. Echocardiography is essential for the diagnosis of left ventricular dysfunction in even subclinical cases and for follow-up of patients with apparently normal left ventricular function. Magnetic resonance imaging holds promise for an effective non-invasive diagnostic tool. Either for acute Pericarditis or myoPericarditis there is a lack for adequate controlled clinical trials. In myoPericarditis the use of NSAID should be cautious, because in animal models of myocarditis, NSAID are not effective and may actually enhance the myocarditic process and increase mortality. In clinical practice lower anti-inflammatory doses are mainly considered to control symptoms. The natural history of myoPericarditis in large populations is not known with accuracy. On follow-up, the majority of these cases had objective normalization of echocardiography, electrocardiography, laboratory testing, and functional status, although up to 14% may report atypical, non-limiting chest discomfort. Unfortunately, few data have been published on myoPericarditis, the paper reviews current available evidence on the presentation, management, and prognosis of myoPericarditis.
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prognosis of idiopathic recurrent Pericarditis as determined from previously published reports
American Journal of Cardiology, 2007Co-Authors: Massimo Imazio, Antonio Brucato, Yehuda Adler, G Brambilla, Galit Artom, Enrico Cecchi, Giancarlo Palmieri, Rita TrincheroAbstract:After a systematic review of all publications on recurrent Pericarditis from 1966 to 2006, we identified 8 major clinical series including a total of 230 patients with idiopathic recurrent Pericarditis (mean age 46 years, men/women ratio: 0.9). After a mean follow-up of 61 months, the complication rate was 3.5% cardiac tamponade and 0% constrictive Pericarditis and left ventricular dysfunction. The overall life prognosis is excellent in idiopathic recurrent Pericarditis and complications are uncommon. In conclusion constrictive Pericarditis was never reported despite numerous recurrences, and the risk is lower than in idiopathic acute Pericarditis (approximately 1%). Thus, it is important to reassure patients on their prognosis, explaining the nature of the disease, and the likely course. Therapeutic choices should take into account of the overall good outcome of these patients, including less toxic agents.
Bongani M Mayosi - One of the best experts on this subject based on the ideXlab platform.
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Pericarditis-associated atrial fibrillation
Heart (British Cardiac Society), 2015Co-Authors: Bongani M MayosiAbstract:There are very few prospective clinical studies of the frequency and outcome of atrial fibrillation in the context of Pericarditis. The early reports in the English literature showed that atrial fibrillation was uncommon in acute Pericarditis (≤7% of cases) and was associated with underlying structural heart disease of the myocardium, valves or coronary arteries.1 It is also known that PQ-segment depression (a marker of atrial Pericarditis) is associated with the occurrence of atrial fibrillation in acute Q-wave myocardial infarction.2 A small prospective study of subacute Pericarditis shows that atrial fibrillation may be common in tuberculous pericardial effusion (∼25% of cases) associated with left ventricular dysfunction and high N-terminal pro-brain natriuretic peptide levels.3 Pericarditis-associated atrial fibrillation is a transient condition that remits spontaneously within 6 weeks of treatment with antituberculosis medication in patients tuberculous pericardial effusion.3 By contrast, chronic constrictive tuberculous Pericarditis is associated with persistent atrial fibrillation in 8% of cases, and usually occurs with a calcified pericardium.4 Imazio et al 5 report probably the first and largest study of the natural history of atrial fibrillation associated with acute Pericarditis to date. They conducted a prospective study of the frequency and prognosis of atrial fibrillation or flutter in 822 consecutive patients with acute Pericarditis who presented to two cardiology referral centres in Athens, Greece and Torino, Italy between January 2006 and June 2014. The diagnosis of acute Pericarditis was based on standard criteria, and Pericarditis-associated atrial fibrillation or flutter was defined as a first episode of the …
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Medical therapy of pericardial diseases: part II: Noninfectious Pericarditis, pericardial effusion and constrictive Pericarditis.
Journal of cardiovascular medicine (Hagerstown Md.), 2010Co-Authors: Massimo Imazio, David H Spodick, Antonio Brucato, Rita Trinchero, Bongani M Mayosi, Francesco Giuseppe Derosa, Chiara Lestuzzi, Antonio Macor, Yehuda AdlerAbstract:The treatment of pericardial diseases is largely empirical because of the relative lack of randomized trials compared with other cardiovascular diseases. The main forms of pericardial diseases that can be encountered in the clinical setting include acute and recurrent Pericarditis, pericardial effusion with or without cardiac tamponade, and constrictive Pericarditis. Medical treatment should be targeted at the cause as much as possible. In this article, the therapy of more common forms of noninfectious Pericarditis (Pericarditis in systemic autoimmune diseases and neoplastic pericardial disease), pericardial effusion, and constrictive Pericarditis is reviewed.
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contemporary trends in the epidemiology and management of cardiomyopathy and Pericarditis in sub saharan africa
Heart, 2007Co-Authors: Bongani M MayosiAbstract:Heart failure in sub-Saharan Africans is mainly due to non-ischaemic causes, such as hypertension, rheumatic heart disease, cardiomyopathy and Pericarditis. The two endemic diseases that are major contributors to the clinical syndrome of heart failure in Africa are cardiomyopathy and Pericarditis. The major forms of endemic cardiomyopathy are idiopathic dilated cardiomyopathy, peripartum cardiomyopathy and endomyocardial fibrosis. Endomyocardial fibrosis, which affects children, has the worst prognosis. Other cardiomyopathies have similar epidemiological characteristics to those of other populations in the world. HIV infection is associated with occurrence of HIV-associated cardiomyopathy in patients with advanced immunosuppression, and the rise in the incidence of tuberculous Pericarditis. HIV-associated tuberculous Pericarditis is characterised by larger pericardial effusion, a greater frequency of myoPericarditis, and a higher mortality than in people without AIDS. Population-based studies on the epidemiology of heart failure, cardiomyopathy and Pericarditis in Africans, and studies of new interventions to reduce mortality, particularly in endomyocardial fibrosis and tuberculous Pericarditis, are needed.
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Tuberculous Pericarditis.
Circulation, 2005Co-Authors: Bongani M Mayosi, Lesley J Burgess, Anton F DoubellAbstract:The incidence of tuberculous Pericarditis is increasing in Africa as a result of the human immunodeficiency virus (HIV) epidemic. The primary objective of this article was to review and summarize the literature on the pathogenesis, diagnosis, and management of tuberculous Pericarditis. We searched MEDLINE (January 1966 to May 2005) and the Cochrane Library (Issue 1, 2005) for information on relevant references. A "definite" diagnosis of tuberculous Pericarditis is based on the demonstration of tubercle bacilli in pericardial fluid or on a histological section of the pericardium; "probable" tuberculous Pericarditis is based on the proof of tuberculosis elsewhere in a patient with otherwise unexplained Pericarditis, a lymphocytic pericardial exudate with elevated adenosine deaminase levels, and/or appropriate response to a trial of antituberculosis chemotherapy. Treatment consists of the standard 4-drug antituberculosis regimen for 6 months. It is uncertain whether adjunctive corticosteroids are effective in reducing mortality or progression to constriction. Surgical resection of the pericardium remains the appropriate treatment for constrictive Pericarditis. The timing of surgical intervention is controversial, but many experts recommend a trial of medical therapy for noncalcific pericardial constriction, and pericardiectomy in nonresponders after 4 to 8 weeks of antituberculosis chemotherapy. Research is needed to improve the diagnosis, assess the effectiveness of adjunctive steroids, and determine the impact of HIV infection on the outcome of tuberculous Pericarditis.
David H Spodick - One of the best experts on this subject based on the ideXlab platform.
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Medical therapy of pericardial diseases: part II: Noninfectious Pericarditis, pericardial effusion and constrictive Pericarditis.
Journal of cardiovascular medicine (Hagerstown Md.), 2010Co-Authors: Massimo Imazio, David H Spodick, Antonio Brucato, Rita Trinchero, Bongani M Mayosi, Francesco Giuseppe Derosa, Chiara Lestuzzi, Antonio Macor, Yehuda AdlerAbstract:The treatment of pericardial diseases is largely empirical because of the relative lack of randomized trials compared with other cardiovascular diseases. The main forms of pericardial diseases that can be encountered in the clinical setting include acute and recurrent Pericarditis, pericardial effusion with or without cardiac tamponade, and constrictive Pericarditis. Medical treatment should be targeted at the cause as much as possible. In this article, the therapy of more common forms of noninfectious Pericarditis (Pericarditis in systemic autoimmune diseases and neoplastic pericardial disease), pericardial effusion, and constrictive Pericarditis is reviewed.
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pericardial disease in renal patients
Seminars in Nephrology, 2001Co-Authors: Srinivas R Gunukula, David H SpodickAbstract:Pericardial disease is common in patients with renal disease. Approximately 20% of uremic patients requiring chronic dialysis develop uremic Pericarditis or dialysis Pericarditis. In all forms of uremic Pericarditis, cardiac tamponade is the main danger. Pericardial contents are sterile unless secondarily infected. Differential diagnosis may be difficult, especially in mentally confused patients and because nonuremic intercurrent Pericarditis of any cause is always possible. In uremic patients, frequent autonomic impairment and decreased cardiac adenylate cyclase limit heart rate increases during Pericarditis, even during tamponade, so that the heart rate may be deceptively slow even with fever and hypotension. Adequate renal dialysis effectively ends uremic Pericarditis. Several factors are associated with precipitating dialysis Pericarditis and effusion, above all inadequate dialysis. Pericarditis in hepatorenal failure occurs at relatively low blood urea nitrogen levels and does not respond to dialysis.