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Diagnosis of systemic inflammatory diseases among patients admitted for acute pericarditis with pericardial effusion

Assayag, Maureena; Abbas, Rachidb; Chanson, Noémiea; Perozziello, Annec; Ducrocq, Gregoryd,f; Alexandra, Jean-Françoisa; Dossier, Antoinea; Papo, Thomasa,e,f; Sacre, Karima,e,f

Journal of Cardiovascular Medicine: November 2017 - Volume 18 - Issue 11 - p 875–880
doi: 10.2459/JCM.0000000000000576
Research articles: Pericarditis and myocarditis

Aims Acute pericarditis may be the heralding manifestation of various systemic inflammatory diseases (SIDs). The aim of this study was to identify clinical indicators for SIDs in patients admitted for acute pericarditis with pericardial effusion.

Methods All consecutive adult patients hospitalized in a Department of Internal Medicine over a 10-year period for acute pericarditis with pericardial effusion were retrospectively reviewed. Patients with cancer and tuberculosis were excluded. A structured clinical panel for extra-cardiac symptoms of SIDs was applied. SIDs were classified using current international criteria.

Results Ninety-nine patients were admitted for acute pericarditis with pericardial effusion. After exclusion, 74 (49.7 ± 19.7 years, 56.7% women) patients were analyzed. Among them, 23 (23.2%) patients had a SID that was revealed by pericarditis in 12 cases. Systemic lupus erythematosus, undifferentiated connective-tissue disease, and Sjogren's syndrome accounted for 75% of the SID. Patients with SIDs were younger (P < 0.001), more frequently of female sex (P = 0.025), and had a higher frequency of extra-cardiac symptoms (P < 0.001) including arthralgia, myalgia, Raynaud phenomenon, and skin rash, as compared with patients with idiopathic pericarditis (n = 51). Overall, after exclusion of neoplasm and tuberculosis, the probability of SIDs in patients admitted with an acute pericarditis with pericardial effusion was 89.7% in patients younger than 50 who had extra-cardiac symptoms. Conversely, the probability fell to 8.4% in patients older than 50 with no extra-cardiac symptoms.

Conclusion Both age and extra-cardiac symptoms suggest an underlying SID as a possible cause of acute pericarditis.

aDépartement de Médecine Interne

bDépartement d’Epidémiologie et Recherche Clinique

cDépartement d’Information Médicale

dDépartement de Cardiologie, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris

eINSERM U1149

fDépartement Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases), Paris, France

Correspondence to Professor Karim Sacre, MD, PhD, Department of Internal Medicine, Bichat Hospital, APHP, 46 rue Henri Huchard, 75018 Paris, France Tel: +33 140256019; fax: +33 140258845; e-mail: karim.sacre@aphp.fr

Received 16 April, 2017

Revised 21 August, 2017

Accepted 2 September, 2017

© 2017 Italian Federation of Cardiology. All rights reserved.