The Evolving Etiological and Epidemiological Portrait of Pericardial Disease


      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.


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