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Multimodality imaging in patients with post-cardiac injury syndrome
  1. Beni R Verma1,
  2. Michael Chetrit1,
  3. James L Gentry III1,
  4. Andrew Noll1,
  5. Ahmed Bafadel1,
  6. Mohamed Khayata1,
  7. Serge C Harb1,
  8. Bo Xu1,
  9. Apostolos Kontzias2,
  10. Deborah H Kwon1,
  11. Christine Jellis1,
  12. Allan L Klein1
  1. 1 Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States
  2. 2 Rheumatology, Allergy and Immunology, Stony Brook University, Stony Brook, New York, United States
  1. Correspondence to Dr Allan L Klein, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA; kleina{at}ccf.org

Abstract

This review article is focused on the role of echocardiography, cardiac CT and cardiac magnetic resonance (CMR) imaging in diagnosing and managing patients with post-cardiac injury syndrome (PCIS). Clinically, the spectrum of pericardial diseases under PCIS varies not only in form and severity of presentation but also in the timing varying from weeks to months, thus making it difficult to diagnose. Pericarditis developing after recent or remote myocardial infarction, cardiac surgery or ablation if left untreated or under-treated could worsen into complicated pericarditis which can lead to decreased quality of life and increased morbidity. Colchicine in combination with other anti-inflammatory agents (non-steroidal anti-inflammatory drugs) is proven to prevent and treat acute pericarditis as well as its relapses under various scenarios. Imaging modalities such as echocardiography, CT and CMR play a pivotal role in diagnosing PCIS especially in difficult cases or when clinical suspicion is low. Echocardiography is the tool of choice for emergent bedside evaluation for cardiac tamponade and to electively study the haemodynamics impact of constrictive pericarditis. CT can provide information on pericardial thickening, calcification, effusions and lead perforations. CMR can provide pericardial tissue characterisation, haemodynamics changes and guide long-term treatment course with anti-inflammatory agents. It is important to be familiar with the indications as well as findings from these multimodality imaging tools for clinical decision-making.

  • cardiac computer tomographic (CT) imaging
  • cardiac magnetic resonance (CMR) imaging
  • echocardiography
  • pericardial disease
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Footnotes

  • Contributors All authors listed in the authorship have significantly contributed to this manuscript so as to be included as authors. They are qualified to be authors and are listed in the author byline. All authors have read and approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer ALK receives honorarium from Sobi and Pfizer pharmaceuticals. Also, he receives research grant from Kiniksa pharmaceuticals. He also receives book royalty from Wolters Kluwer & ELSEVIER.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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