CMR helps hone treatment for recurrent pericarditis

Cardiac MR (CMR) can help guide therapy in patients with recurrent pericarditis. One center reported patients who underwent imaging received a smaller total dose of steroids and experienced fewer recurrences than patients who did not get scans.

M. Chadi Alraies, MD, of the Heart & Vascular Institute at the Cleveland Clinic, and colleagues identified 507 patients in the clinic’s pericardial disease database who were treated for recurrent pericarditis between 2007 and 2011. Physicians at the clinic had the option to use CMR with late gadolinium enhancement to assess inflammation in their patients. A total of 257 patients were managed using CMR and 250 were managed without CMR.

The therapies for treating recurrent pericarditis include nonsteroidal anti-inflammatory drugs (NSAIDS) and colchicine. If those fail, patients may then receive oral steroids. But that strategy may be premature if physicians had not waited long enough to let NSAIDS take effect.

In their study published in the February issue of the American Journal of Cardiology, Alraies et al argued that CMR offers an objective method to assess inflammation, which might influence cardiologists’ decisions about treatment and therefore affect patient outcomes.

At a mean follow-up of 17 months, the CMR group received less steroid therapy than the other group (a total of 546.4 vs. 1,695.4 milligrams of steroids, respectively). Their duration of therapy to freedom of disease was half as long, at six months vs. 13 months, and they had fewer recurrences.

“Steroids are very effective medications, but they are associated with serious side effects that can be more disabling than RP [recurrent pericarditis],” Alraies et al wrote. Avoiding the burden and costs of those potential complications may justify the cost of CMR, they added, but that would need to be supported by research.

They acknowledged that their study was limited by being small, retrospective and based in single referral center. Physicians used CMR at their discretion, which may have introduced bias as well.