ABSTRACT
Pericardial disease includes a variety of pericardial diseases including inflammatory
pericarditis, pericardial effusions, constrictive pericarditis, pericardial cysts,
primary and secondary pericardial neoplasms. The true incidence of this varied condition
is not well established, and the causes vary greatly across the world. This review
aims to describe the changing pattern of epidemiology of pericardial disease and to
provide an overview of causative etiologies. Idiopathic pericarditis (assumed most
often to be viral) remains the most common etiology for pericardial disease globally,
with tuberculous pericarditis being most common in developing countries. Other important
etiologies include fungal, autoimmune, autoinflammatory, neoplastic (both benign and
malignant), immunotherapy-related, radiation therapy-induced, metabolic, post cardiac
injury, post-operative, and post-procedural causes. Improved understanding of the
immune pathophysiologic pathways has led to identification and reclassification of
some idiopathic pericarditis cases into autoinflammatory etiologies, including IgG4-related
pericarditis, tumor necrosis factor receptor-associated periodic syndrome (TRAPS)
and familial Mediterranean fever in the current era. Contemporary advances in percutaneous
cardiac interventions and the recent Covid-19 pandemic have also resulted in changes
in the epidemiology of pericardial diseases. Further research is needed to improve
our understanding of the etiologies of pericarditis, utilizing the assistance of contemporary
advanced imaging techniques and laboratory testing. Careful consideration of the range
of potential causes and local epidemiological patterns of causality are important
for the optimization of diagnostic and therapeutic approaches.
KEYWORDS
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Canadian Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Evaluation and Treatment of Pericarditis: A Systematic Review.JAMA. 2015; 314: 1498-1506
- Management of Acute and Recurrent Pericarditis: JACC State-of-the-Art Review.J Am Coll Cardiol. 2020; 75: 76-92
- 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS).Eur Heart J. 2015; 36: 2921-2964
- Contemporary trends in the epidemiology and management of cardiomyopathy and pericarditis in sub-Saharan Africa.Heart. 2007; 93: 1176-1183
- Controversial issues in the management of pericardial diseases.Circulation. 2010; 121: 916-928
- Triage and management of pericardial effusion.J Cardiovasc Med (Hagerstown). 2010; 11: 928-935
- Causes of moderate to large pericardial effusion requiring pericardiocentesis in 140 Han Chinese patients.Herz. 2012; 37: 183-187
- Etiologic diagnosis of 204 pericardial effusions.Medicine (Baltimore). 2003; 82: 385-391
- Epidemiology of pericardial effusions at a large academic hospital in South Africa.Epidemiol Infect. 2005; 133: 393-399
- Clinical clues to the causes of large pericardial effusions.Am J Med. 2000; 109: 95-101
- Interleukin-1 and the Inflammasome as Therapeutic Targets in Cardiovascular Disease.Circ Res. 2020; 126: 1260-1280
- An update on the pathophysiology of acute and recurrent pericarditis.Panminerva Med. 2021; 63: 249-260
- Anti-interleukin-1 agents for pericarditis: a primer for cardiologists.Eur Heart J. 2022; 43: 2946-2957
- Prevalence of Clinical and Subclinical Myocarditis in Competitive Athletes With Recent SARS-CoV-2 Infection: Results From the Big Ten COVID-19 Cardiac Registry.JAMA Cardiol. 2021; 6: 1078-1087
- 2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play: A Report of the American College of Cardiology Solution Set Oversight Committee.J Am Coll Cardiol. 2022; 79: 1717-1756
- Prevalence, Characteristics, and Outcomes of COVID-19-Associated Acute Myocarditis.Circulation. 2022; 145: 1123-1139
- Viral Myocarditis-Incidence, Diagnosis and Management.J Cardiothorac Vasc Anesth. 2020; 34: 1591-1601
- Acute myopericarditis after multiple vaccinations in an adolescent: case report and review of the literature.Pediatrics. 2007; 119: e1400-e1403
- Recurrence of pericarditis after influenza vaccination: a case report and review of the literature.BMC Pharmacol Toxicol. 2018; 19: 20
- Symptomatic pericarditis after influenza vaccination: report of two cases.Chest. 2000; 117: 1803-1805
- Safety of the BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Setting.N Engl J Med. 2021; 385: 1078-1090
- SARS-CoV-2 Vaccination and Myocarditis in a Nordic Cohort Study of 23 Million Residents.JAMA Cardiol. 2022; 7: 600-612
- Myocarditis After SARS-CoV-2 Vaccination: A Vaccine-Induced Reaction?.Can J Cardiol. 2021; 37: 1665-1667
- Myocarditis and Pericarditis After COVID-19 mRNA Vaccination: Practical Considerations for Care Providers.Can J Cardiol. 2021; 37: 1629-1634
- Prognosis of Myocarditis Developing After mRNA COVID-19 Vaccination Compared With Viral Myocarditis.J Am Coll Cardiol. 2022; 80: 2255-2265
- Myocarditis following COVID-19 vaccine: incidence, presentation, diagnosis, pathophysiology, therapy, and outcomes put into perspective. A clinical consensus document supported by the Heart Failure Association of the European Society of Cardiology (ESC) and the ESC Working Group on Myocardial and Pericardial Diseases.Eur J Heart Fail. 2022; 24: 2000-2018
- Diagnosing tuberculous pericarditis.QJM. 2006; 99: 827-839
- Purulent pericarditis: review of a 20-year experience in a general hospital.J Am Coll Cardiol. 1993; 22: 1661-1665
- Candida pericarditis: clinical profile and treatment.Ann Thorac Surg. 1997; 63: 1200-1204
- A case report of purulent pericarditis caused by Candida albicans: Delayed complication forty-years after esophageal surgery.Medicine (Baltimore). 2018; 97e11286
- Fulminant Cryptococcus neoformans infection with fatal pericardial tamponade in a patient with chronic myelomonocytic leukaemia who was treated with ruxolitinib: Case report and review of fungal pericarditis.Mycoses. 2018; 61: 245-255
- Pericardial computed tomography imaging findings in the setting of coccidioidomycosis.BMC Infect Dis. 2022; 22: 623
- Pericarditis in Systemic Rheumatologic Diseases.Curr Cardiol Rep. 2020; 22: 142
- Indicators of poor prognosis of acute pericarditis.Circulation. 2007; 115: 2739-2744
Dein, E., et al., Pericarditis in Lupus. Cureus, 2019. 11(3): p. e4166.
- The extra-articular features of rheumatoid arthritis. A systematic analysis of 127 cases.Am J Med. 1973; 54: 445-452
Voskuyl, A.E., The heart and cardiovascular manifestations in rheumatoid arthritis. Rheumatology (Oxford), 2006. 45 Suppl 4: p. iv4-7.
- Cardiorheumatology: cardiac involvement in systemic rheumatic disease.Nat Rev Cardiol. 2015; 12: 168-176
- Rheumatoid pericarditis: clinical features and survival.Medicine (Baltimore). 1990; 69: 81-91
- Cardiovascular Manifestations of Systemic Sclerosis: A Danish Nationwide Cohort Study.J Am Heart Assoc. 2019; 8: e013405
- Molecular mechanisms in genetically defined autoinflammatory diseases: disorders of amplified danger signaling.Annu Rev Immunol. 2015; 33: 823-874
- Pericarditis as a manifestation of IgG4-related disease.Rheumatol Int. 2022; 42: 1287-1295
- IgG4-related disease: dataset of 235 consecutive patients.Medicine (Baltimore). 2015; 94: e680
- Cardiac manifestations of Familial Mediterranean fever.Avicenna J Med. 2017; 7: 158-163
- Familial Mediterranean fever (FMF) in Turkey: results of a nationwide multicenter study.Medicine (Baltimore). 2005; 84: 1-11
- The phenotype of TNF receptor-associated autoinflammatory syndrome (TRAPS) at presentation: a series of 158 cases from the Eurofever/EUROTRAPS international registry.Ann Rheum Dis. 2014; 73: 2160-2167
- Clues to detect tumor necrosis factor receptor-associated periodic syndrome (TRAPS) among patients with idiopathic recurrent acute pericarditis: results of a multicentre study.Clin Res Cardiol. 2012; 101: 525-531
- Adult-onset Still's disease-pathogenesis, clinical manifestations, and new treatment options.Ann Med. 2015; 47: 6-14
Elkholy, K.O., H. Akhtar, and A. Chakraborti, A Case of Seronegative ANA Hydralazine-Induced Lupus Presenting With Pericardial Effusion and Pleural Effusion. Cureus, 2020. 12(8): p. e9831.
Maisch, B., et al., Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. Eur Heart J, 2004. 25(7): p. 587-610.
- Implications of echocardiographically assisted diagnosis of pericardial tamponade in contemporary medical patients: detection before hemodynamic embarrassment.J Am Coll Cardiol. 1991; 17: 59-65
- Cardiotoxicities of novel cancer immunotherapies.Heart. 2021; 107: 1694-1703
- Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update.J Clin Oncol. 2021; 39: 4073-4126
- Cancer Treatment-Associated Pericardial Disease: Epidemiology, Clinical Presentation, Diagnosis, and Management.Curr Cardiol Rep. 2019; 21: 156
- Experience With Pericardiectomy for Constrictive Pericarditis Over Eight Decades.Ann Thorac Surg. 2017; 104: 742-750
- Outcomes of pericardiectomy for constrictive pericarditis following mediastinal irradiation.J Card Surg. 2021; 36: 4636-4642
- Current concepts of diagnosis and management of pericardial cysts.Indian Heart J. 2017; 69: 364-370
- Primary pericardial tumors.Radiographics. 2013; 33: 1613-1630
- Pericardial lipoma: an autopsy case and review of the literature.J Forensic Sci. 2007; 52: 949-950
Grebenc, M.L., et al., Primary cardiac and pericardial neoplasms: radiologic-pathologic correlation. Radiographics, 2000. 20(4): p. 1073-1103; quiz 1110-1, 1112.
Lamba, G. and W.H. Frishman, Cardiac and pericardial tumors. Cardiol Rev, 2012. 20(5): p. 237-252.
- Benign Pericardial Hemangioma-A Rare Cause of Cardiac Tamponade.Indian J Radiol Imaging. 2021; 31: 754-757
- MRI of the Pericardium.Radiographics. 2019; 39: 1921-1922
- Cardiac MRI: Part 2, pericardial diseases.AJR Am J Roentgenol. 2011; 197: W621-W634
- Computed tomography of the pericardium and pericardial disease.J Cardiovasc Comput Tomogr. 2010; 4: 3-18
- Primary pericardial mesothelioma.Curr Treat Options Oncol. 2002; 3: 369-373
- Primary cardiac lymphoma: an analysis of presentation, treatment, and outcome patterns.Cancer. 2011; 117: 581-589
- Primary Cardiac Sarcoma: 25-Year Cleveland Clinic Experience.Am J Clin Oncol. 2016; 39: 593-599
- Images in cardiovascular medicine. Cardiac involvement in Erdheim-Chester disease: magnetic resonance and computed tomographic scan imaging in a monocentric series of 37 patients.Circulation. 2009; 119: e597-e598
- Uremic pericarditis, pericardial effusion, and constrictive pericarditis in end-stage renal disease: Insights and pathophysiology.Clin Cardiol. 2017; 40: 839-846
- Uremic pericarditis in patients with End Stage Renal Disease: Prevalence, symptoms and outcome in 2017.Am J Emerg Med. 2018; 36: 464-466
- Pericarditis in end-stage renal disease.Cardiol Clin. 1990; 8: 701-707
- Pericardial effusion and left ventricular dysfunction associated with ascites secondary to hepatic cirrhosis.Arch Intern Med. 1988; 148: 585-588
- Disappearance of a syndrome: Dressler's syndrome in the era of thrombolysis.Cardiology. 1994; 85: 255-258
- Post-pericardiotomy syndrome: insights into neglected postoperative issues.Eur J Cardiothorac Surg. 2022; 61: 505-514
- Contemporary features, risk factors, and prognosis of the post-pericardiotomy syndrome.Am J Cardiol. 2011; 108: 1183-1187
- Occurrence of Postpericardiotomy Syndrome: Association With Operation Type and Postoperative Mortality After Open-Heart Operations.J Am Heart Assoc. 2018; 7: e010269
- Relationship between the degree of injury at operation and the change in antimyosin antibody titer in the postpericardiotomy syndrome.Pediatr Cardiol. 1994; 15: 116-120
- Postpericardiotomy syndrome after cardiac surgery.Ann Med. 2020; 52: 243-264
Lee, Y.J., et al., Pacemaker-Associated Post-cardiac Injury Syndrome Presenting with Tamponade and Recurrent Pleural Effusion. Clin Med Insights Case Rep, 2020. 13: p. 1179547620965559.
- Postcardiac injury syndrome after cardiac implantable electronic device implantation.Herz. 2020; 45: 696-702
- A Leadless Intracardiac Transcatheter Pacing System.N Engl J Med. 2016; 374: 2604-2605
- Leadless pacemaker perforations: Clinical consequences and related device and user problems.J Cardiovasc Electrophysiol. 2022; 33: 154-159
- Endomyocardial biopsy.Ann Intern Med. 1982; 97: 885-894
- Acute pericarditis after atrial fibrillation ablation: Incidence, characteristics, and risk factors.Heart Rhythm O2. 2022; 3: 248-251
Darmoch, F., et al., National trends of acute pericarditis post-atrial fibrillation ablation. Int J Clin Pract, 2020. 74(1): p. e13434.
- Acute pericarditis following second-generation cryoballoon ablation for atrial fibrillation.J Interv Card Electrophysiol. 2018; 51: 279-284
- Influence of steroid therapy on the incidence of pericarditis and atrial fibrillation after percutaneous epicardial mapping and ablation for ventricular tachycardia.Circ Arrhythm Electrophysiol. 2014; 7: 671-676
- Incidence and Management of Hemopericardium: Impact of Changing Trends in Invasive Cardiology.Mayo Clin Proc. 2018; 93: 1086-1095
Shah, K., et al., Temporal Trend, Prevalence, Predictors, and Outcomes of Pericardial Diseases in Patients Undergoing Transcatheter Aortic Valve Repair. Cureus, 2021. 13(7): p. e16083.
Article info
Publication history
Accepted:
May 17,
2023
Received in revised form:
May 17,
2023
Received:
January 9,
2023
Publication stage
In Press Journal Pre-ProofFootnotes
Disclosures:
Dr. Luis is a consultant for Kiniksa Pharmaceuticals, SOBI Pharmaceuticals and Medtronic. None of the other authors have any relevant financial disclosures.
Funding sources: None
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
