In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.
Did you know that your browser is out of date? To get the best experience using our website we recommend that you upgrade to a newer version. Learn more.

We use cookies to optimise the design of this website and make continuous improvement. By continuing your visit, you consent to the use of cookies. Learn more

Revised ESC Guidelines on Pericardial Diseases

ESC Congress News 2015 - London

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.

Cardio-Oncology
Pericardial Disease
Cardiovascular Surgery


Access the Guidelines here

Oslo University Hospital Ullevål, Norway Stephan Achenbach, University of Erlangen, GermanyThe 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.

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, responsiblefor 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 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.

Access all ESC Clinical Practice Guidelines here