ESC Congress Reports 2006

Session Number : 927000 Session Title: Treatment in different forms of pericarditis Symposium Core syllabus topic : Pericardial Disease	Assoc. Prof. Ozlem Soran
Date : 3 September 2006 Reported by : Soran, O. Pittsburgh, United States
What is new in the treatment of Pericarditis?
The aetiological classification of pericarditis comprises infectious pericarditis, pericarditis in systemic auto-immune diseases, type 2 (auto) immune process, post-myocardial infarction syndrome and auto-reactive pericarditis. In pericarditis, not only the incidence and pathogenesis are different, but the treatment choices differ as well. Professors B Maisch (Marburg, Germany), A D Ristic (Belgrade, Serbia) , J Soler-Soler (Barcelona, Spain) and W Z Tomkowski (Warsaw, Poland) discussed the treatment options at a session on “Treatment in different forms of pericarditis”. The speakers emphasised that with the application of standard clinical, biochemical and cytological methods only, the aetiology of the majority of acute and chronic/recurrent pericarditis cases remains unresolved. However, many of these idiopathic cases will represent either viral infections or auto-reactive pericarditis. In virus-positive effusions any form of corticosteroid treatment is contra-indicated. In auto-reactive effusions, colchicine has been shown to be efficacious. However, a substantial number of patients with chronic forms are resistant to either non-steroidal anti-inflammatory treatment or colchicine. The remaining classic treatment options, such as systemic glucocorticoid treatment, almost always have considerable side effects. In patients with chronic auto-reactive pericardial effusions, intrapericardila instillation of crystalloid glucocorticoids could help avoid systemic side effects, while still allowing high local dose application. This concept has proven its long-term efficacy in recent studies. In the treatment of tuberculus pericarditis the use of prednisone as an adjunct to anti-tuberculosis drugs was recommended. The use of pericardioscopy over pericardiocentesis, in cases with a large pericardial effusion, or cardiac tamponade, in cases with a high probability of tuberculosis, was also recommended. The speakers also stressed that pericardiectomy must be considered as the last treatment option, due to its potential risks and the discomfort caused to patients by sternotomy and the haemodynamic consequences of cardiac stiffness. However, in cases of permanent construction, pericardiectomy is the only treatment.
Conclusion Although treatment in the various forms of pericarditis is different, the goals of treatment are the same: i.e. determination of the aetiology, relief of symptoms, improvement of pericardial inflammation and mechanical efficiency of the heart, decreased rate of constrictive pericarditis - prevention of progression from effusive to the constrictive stage, and a decreased mortality rate. To reach these goals I believe there is still a strong need for randomised studies comprising more patients and resolving the remaining questions such as the use of corticosteroids in tuberculus pericarditis , timing of pericardiectomy and the long-term effect of intrapericardial treatment with low doses of the crystalloid corticosteroids.