International Journal of Cardiology 177 (2014) 139
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Is recurrent pericarditis a risk for constrictive evolution? Lovely Chhabra a,⁎, David H. Spodick b a b
Dept. of Cardiovascular Medicine, Hartford Hospital, University of Connecticut School of Medicine, Hartford, CT 06102, USA Saint Vincent Hospital, University of Massachusetts Medical School, Worcester MA 01608, USA
a r t i c l e
i n f o
Article history: Received 1 September 2014 Accepted 20 September 2014 Available online 28 September 2014 Keywords: Pericarditis Nonidiopathic Constrictive Recurrent Colchicine
Dear Editor: We read with great interest the work by Kytö et al. which studied the incidence and etiopathogenesis of constrictive pericarditis (CP) in the general population [1]. Authors describe recurrent/persistent viral pericarditis as a risk factor for development of CP in their study introduction. Indeed, constrictive evolution is a feared complication by clinicians, especially when the disease is unresponsive to conventional therapy or the course is recurrent or incessant. However, this is a common misconception and it is important to recognize that idiopathic recurrent or incessant pericarditis does not pose a risk for constriction. A large systematic review involving 8 major clinical series and 230 patients with idiopathic recurrent pericarditis did not show an increased risk for developing CP [2]. Another large prospective study specifically evaluating the risk of CP development in patients with acute pericarditis again confirmed that idiopathic (presumably viral) recurrent forms do not lead to constriction, however recurrent or incessant course may be a risk for constriction in non-idiopathic forms of pericarditis [3]. Thus, constrictive evolution of recurrent pericarditis correlates to the etiology as opposed to the number of recurrences. Interestingly, in this series, the most common etiology for CP was autoimmune pericarditis (rheumatoid arthritis), as opposed to the previous reports where etiologies such as postoperative, neoplastic
⁎ Corresponding author at: 80 Seymour Street, Hartford, CT 06102, USA. Tel.: +1 860 545 5000; fax: +1 888 598 6647. E-mail address: [email protected] (L. Chhabra).
http://dx.doi.org/10.1016/j.ijcard.2014.09.107 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
and purulent pericarditis have been reported to be the commonest causes of CP in developed countries. An autoimmune etiology may act as a persistent trigger for pericardial inflammation and thus may potentially be a risk factor for constriction (nonidiopathic form). Thus, another important issue becomes the consideration of preventing constriction in nonidiopathic recurrent pericarditis with use of appropriate therapies. Colchicine which has a proven role in recurrent idiopathic or viral pericarditis has not been widely investigated in treating recurrent nonidiopathic pericarditis [4]. CORP-2 post-hoc analysis showed N 10% reduction in the recurrence of nonidiopathic pericarditis in patients treated with colchicine [4–6]. This is perhaps a significant benefit and may reach statistical significance in larger-sized prospective studies. Thus, it may be probably reasonable to consider using colchicine in combination with standard therapies for the treatment of nonidiopathic pericarditis (such as autoimmune pericarditis). Although the development of constriction was infrequent (in placebo arms of ICAP [n = 1], CORP [n = 0], and CORP-2 [n = 4]), the reduction in incidence of incessant pericarditis, suggests a potential prognostic benefit of colchicine for prevention of CP development in nonidiopathic etiologies [5]. Conflict of interest Dr. David Spodick receives royalties from his textbook, “The Pericardium: A Comprehensive Textbook (Fundamental and Clinical Cardiology), Marcel Dekker, New York 1997”. Other authors have no disclosures, financial or otherwise. Funding None. References [1] Kytö V, Sipilä J, Rautava P. Chronic constrictive pericarditis in general adult population. Int J Cardiol 2014;176(3):1158–60. [2] Imazio M, Brucato A, Adler Y, Brambilla G, Artom G, Cecchi E, et al. Prognosis of idiopathic recurrent pericarditis as determined from previously published reports. Am J Cardiol 2007;100(6):1026–8. [3] Imazio M, Brucato A, Maestroni S, Cumetti D, Belli R, Trinchero R, et al. Risk of constrictive pericarditis after acute pericarditis. Circulation 2011;124(11):1270–5. [4] Chhabra L, Khalid N, Spodick DH. Role of colchicine in nonidiopathic pericarditis needs further exploration! Ann Pharmacother 2014;48(10):1396–7. [5] Chhabra L, Dua K, Spodick DH. CORP-2 trial and the role of colchicine in nonidiopathic pericarditis. Nat Rev Cardiol 2014;11(8):442. [6] Imazio M, Belli R, Brucato A, Cemin R, Ferrua S, Begaraj F, et al. Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): a multicentre, double-blind, placebo-controlled, randomised trial. Lancet 2014; 383(9936):2232–7.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Is recurrent pericarditis a risk for constrictive evolution? Lovely Chhabra a,⁎, David H. Spodick b a b
Dept. of Cardiovascular Medicine, Hartford Hospital, University of Connecticut School of Medicine, Hartford, CT 06102, USA Saint Vincent Hospital, University of Massachusetts Medical School, Worcester MA 01608, USA
a r t i c l e
i n f o
Article history: Received 1 September 2014 Accepted 20 September 2014 Available online 28 September 2014 Keywords: Pericarditis Nonidiopathic Constrictive Recurrent Colchicine
Dear Editor: We read with great interest the work by Kytö et al. which studied the incidence and etiopathogenesis of constrictive pericarditis (CP) in the general population [1]. Authors describe recurrent/persistent viral pericarditis as a risk factor for development of CP in their study introduction. Indeed, constrictive evolution is a feared complication by clinicians, especially when the disease is unresponsive to conventional therapy or the course is recurrent or incessant. However, this is a common misconception and it is important to recognize that idiopathic recurrent or incessant pericarditis does not pose a risk for constriction. A large systematic review involving 8 major clinical series and 230 patients with idiopathic recurrent pericarditis did not show an increased risk for developing CP [2]. Another large prospective study specifically evaluating the risk of CP development in patients with acute pericarditis again confirmed that idiopathic (presumably viral) recurrent forms do not lead to constriction, however recurrent or incessant course may be a risk for constriction in non-idiopathic forms of pericarditis [3]. Thus, constrictive evolution of recurrent pericarditis correlates to the etiology as opposed to the number of recurrences. Interestingly, in this series, the most common etiology for CP was autoimmune pericarditis (rheumatoid arthritis), as opposed to the previous reports where etiologies such as postoperative, neoplastic
⁎ Corresponding author at: 80 Seymour Street, Hartford, CT 06102, USA. Tel.: +1 860 545 5000; fax: +1 888 598 6647. E-mail address: [email protected] (L. Chhabra).
http://dx.doi.org/10.1016/j.ijcard.2014.09.107 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
and purulent pericarditis have been reported to be the commonest causes of CP in developed countries. An autoimmune etiology may act as a persistent trigger for pericardial inflammation and thus may potentially be a risk factor for constriction (nonidiopathic form). Thus, another important issue becomes the consideration of preventing constriction in nonidiopathic recurrent pericarditis with use of appropriate therapies. Colchicine which has a proven role in recurrent idiopathic or viral pericarditis has not been widely investigated in treating recurrent nonidiopathic pericarditis [4]. CORP-2 post-hoc analysis showed N 10% reduction in the recurrence of nonidiopathic pericarditis in patients treated with colchicine [4–6]. This is perhaps a significant benefit and may reach statistical significance in larger-sized prospective studies. Thus, it may be probably reasonable to consider using colchicine in combination with standard therapies for the treatment of nonidiopathic pericarditis (such as autoimmune pericarditis). Although the development of constriction was infrequent (in placebo arms of ICAP [n = 1], CORP [n = 0], and CORP-2 [n = 4]), the reduction in incidence of incessant pericarditis, suggests a potential prognostic benefit of colchicine for prevention of CP development in nonidiopathic etiologies [5]. Conflict of interest Dr. David Spodick receives royalties from his textbook, “The Pericardium: A Comprehensive Textbook (Fundamental and Clinical Cardiology), Marcel Dekker, New York 1997”. Other authors have no disclosures, financial or otherwise. Funding None. References [1] Kytö V, Sipilä J, Rautava P. Chronic constrictive pericarditis in general adult population. Int J Cardiol 2014;176(3):1158–60. [2] Imazio M, Brucato A, Adler Y, Brambilla G, Artom G, Cecchi E, et al. Prognosis of idiopathic recurrent pericarditis as determined from previously published reports. Am J Cardiol 2007;100(6):1026–8. [3] Imazio M, Brucato A, Maestroni S, Cumetti D, Belli R, Trinchero R, et al. Risk of constrictive pericarditis after acute pericarditis. Circulation 2011;124(11):1270–5. [4] Chhabra L, Khalid N, Spodick DH. Role of colchicine in nonidiopathic pericarditis needs further exploration! Ann Pharmacother 2014;48(10):1396–7. [5] Chhabra L, Dua K, Spodick DH. CORP-2 trial and the role of colchicine in nonidiopathic pericarditis. Nat Rev Cardiol 2014;11(8):442. [6] Imazio M, Belli R, Brucato A, Cemin R, Ferrua S, Begaraj F, et al. Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): a multicentre, double-blind, placebo-controlled, randomised trial. Lancet 2014; 383(9936):2232–7.
