The 2015 Guidelines on the Diagnosis and Management of Pericardial Diseases released during this congress have been significantly expanded and changed since the previous version of 2004. Much scientific data on prevalence and outcome, as well as entirely new concepts for treatment, have been developed and evaluated – particularly the use of colchicine for the treatment of pericarditis, which now carries a Class IA indication.
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The 2015 Guidelines on the Diagnosis and Management of Pericardial Diseases released during this congress have been significantly expanded and changed since the previous version of 2004. Many scientific data on prevalence and outcome, as well as entirely new concepts for treatment, have been developed and evaluated – particularly the use of colchicine for the treatment of pericarditis, which now carries a Class IA indication.
The new guidelines cover the epidemiology and pathology of pericardial disease, diagnostic and medical management in acute and chronic stages, specific recommendations on exercise restriction, and surgical therapy, and they place great emphasis on specific recommendations for clinical practice.
Pericardial diseases are frequent, and their most common form is pericarditis, responsible for 0.1% of all hospital admissions and 5% of emergency room admissions for chest pain. In developed countries, viral infections are usually the most common cause, with a very good prognosis, while tuberculosis is the most frequent global cause, especially in developing countries where TB is endemic.
The guidelines propose specific criteria for the diagnosis of acute and recurrent disease, with detailed flow charts for the triage of patients with pericarditis and pericardial effusion, allowing the identification of high-risk patients who need to be admitted. Multimodality imaging, including cardiac MRI, has become an essential approach for comprehensive diagnostic evaluation, especially if the concomitant involvement of the myocardium is suspected.
There are a few randomised trials for pericardial disease, so the number of Class IA recommendations is limited. However, multicentre RCTs on the use of colchicine for acute pericarditis have been completed and were able to establish colchicine as a first-line addition to improve response to therapy, increase remission rates, and reduce recurrences. New therapeutic choices have also become available for refractory recurrent pericarditis, including alternative immunosuppressive therapies.
Restriction from physical exercise is a clinically and legally important area in pericardial disease. In acute pericarditis, for example, exercise restriction is recommended until resolution of symptoms and normalisation of inflammatory markers for non-athletes. In competitive athletes, however, exercise restriction for at least three months is recommended by consensus.
The role of surgery has also undergone modification and is more differentiated than in the past. Thus, while pericardectomy has been demonstrated as a possible alternative to additional medical therapies in refractory recurrent pericarditis, the new guidelines also propose medical therapy in acute effusive-constrictive pericarditis in an attempt to avoid surgery.
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