Abstract 15397: Pericardial Delayed Hyperenhancement Predicts Outcomes in Idiopathic Recurrent Pericarditis

Abstract

Introduction: Recurrent pericarditis (RP) is defined as recurrence of pericarditis after an initial documented episode of pericarditis and symptom free interval of four to six weeks. In this study, we aimed to investigate the prognostic value of the pericardial delayed hyperenhancement (DHE) in patients with idiopathic recurrent pericarditis (IRP). Hypothesis: We hypothesize that moderate to severe DHE is correlated with worse outcomes. Methods: Consecutive patients (n=223) with IRP from 2012-2019 were included. Out of 223 patients, 213 had DHE tracing. Patients were then followed for events of clinical improvement (CI), clinical remission (CR), and clinical recurrence. Results: The mean age of the 223 patients included was 45 ± 16 years, and 51% were females. DHE was divided into two groups none/mild (n=160) and moderate/severe (n=53). At baseline, median number of prior recurrences was 3 (Q1, Q3: 2,5). Furthermore, when adjusted for age, gender, prior number of recurrences, and anti-inflammatory therapy on multivariable cox-regression analysis, moderate to severe DHE was independently associated with less likelihood of having CI (HR 0.24, p<0.001) and CR (HR 0.31, p=0.011), and more likelihood of having clinical recurrence (HR 1.58, p=0.02). On Kaplan Meier analysis, moderate to severe DHE was associated with more time to clinical improvement (log rank p<0.0001), more time to clinical remission (log rank p<0.0001), and less time to clinical recurrence (log rank p=0.0047). Conclusions: Moderate to severe DHE is independently correlated with worse outcomes in patients with IRP. DHE should be considered an important part of evaluation in patients with recurrent pericarditis and should be included in new guidelines. Our study will help clinicians utilize DHE as a prognostic marker in patients with IRP.