Acute Pericarditis Research Articles

Re-enforcing High-Risk Acute Pericarditis Requiring Hospital Admission: An Unusual Case of Critical Idiopathic Acute Pericarditis Presenting As Tamponade and Pleuro-Pericardial Complications in a Patient Presenting With Flu-Like Symptoms

Re-enforcing High-Risk Acute Pericarditis Requiring Hospital Admission: An Unusual Case of Critical Idiopathic Acute Pericarditis Presenting As Tamponade and Pleuro-Pericardial Complications in a Patient Presenting With Flu-Like Symptoms

Acute idiopathic pericarditis during a national lockdown to prevent transmission of SARS-COVID-19

BackgroundIdiopathic acute pericarditis is often presumed to have a viral cause. We hypothesized that if acute viral infection was the cause, the incidence of acute ‘idiopathic’ pericarditis would decrease during a public health lockdown introduced to prevent the spread of SARS-COVID-19 in New Zealand when acute viral infections decreased by 75% to 99%. MethodsHospitalization for acute ‘idiopathic’ pericarditis during 5 months of the national public health lockdown were compared to 54 months before the COVID-19 pandemic from administrative data. ResultsThe hospitalization rate for acute pericarditis was similar before (n = 1364, 24.8 cases/30 days) compared to during the public health lockdown (n = 132, 25.8 cases/30 days), +4% 95 % confidence interval −25 % to +30 % (P = 0.67). ConclusionThese observations do not support the hypothesis that acute viral infection is the cause for most cases of acute idiopathic pericarditis.

Pericarditis recurrence is associated with milder electrocardiographic, echocardiographic, and laboratory findings.

Recurrent pericarditis (RP) complicates approximately 30% of acute pericarditis (AP) cases. We sought to compare the prevalence and severity of objective findings seen in patients with RP. A retrospective single-center study during 2010-2019, including 765 patients diagnosed with AP. Clinical, electrocardiographic, echocardiographic, and laboratory findings were extracted from the local electronic health records. Recurrence during follow-up was documented in 134 patients (17.5%), with a median time to recurrence of 101 (± 59-251) days. The median age was 60 years (IQR 45-72), 68% were male. Most patients were defined as having idiopathic\viral pericarditis (64%). The clinical manifestation during the recurrent event of pericarditis was less prominent or attenuated when compared to the initial event-ECG signs (ST elevation 12% vs. 26%; p = 0.006, Knuckle sign 13% vs. 33%; p < 0.001, ST larger in lead L2 than L3 4% vs. 19%; p < 0.001), pericardial effusion moderate and above (11% vs. 30%; p = 0.02), and inflammatory markers (mean peak CRP levels 66 mg/l vs. 97mg/l; p < 0.001). Similar results were seen in the subgroup of patients defined as having idiopathic\viral pericarditis. Up to 20% of patients who did not have ECG signs or a significant pericardial effusion in their 1st event demonstrated these findings during the recurrence, though still to a lesser extent compared with those who had these signs in their 1st event. The objective findings of AP are less pronounced during recurrent events. Future studies should focus on the role of advanced biomarkers and imaging in defining true RP events.

Pericarditis. Causes, Mechanisms of Development, Variants of Course and Therapeutic Approaches in Modern Conditions

Under physiological conditions, the pericardial cavity contains serous fluid (15-50 ml), which belongs to the plasma ultrafiltrate and is visualized during echocardiography only in systole. The thickness of the pericardium in an adult averages 2 mm (1-3 mm). Inflammatory lesions of the pericardium with or without effusion into its cavity can act as an independent disease, and as a secondary manifestation of another pathological condition. Pericarditis of infectious (14-16%) and non-infectious (15-20%) nature, primary and secondary, acute, chronic and recurrent are commonly distinguished. The prevalence of acute and idiopathic recurrent pericarditis is 27.7 per 100,000 population and 5.4-8.1 per 100,000 population, respectively. Currently, idiopathic recurrent pericarditis belongs to polygenic autoinflammatory diseases, where an important role in the initiation of the pathologic process belongs to the inflammatory cytokine — interleukin-1 (β and α). The most characteristic manifestations of acute pericarditis are chest pain, dyspnea and fever. The article summarizes the main aspects of etiology, clinical manifestations, diagnosis and therapy of pericarditis, including the peculiarities of its treatment taking into account specific conditions. A clinical case demonstrated a case of acute effusion pericarditis with recurrence, which was characterized by rapid progression of heart failure symptoms, as well as systemic manifestations (anemia, hypercytokinemia, marked muscle weakness). The results of echocardiography allowed to identify the presence of pericardial effusion. Steroid and non-steroidal anti-inflammatory, anticoagulant and antibacterial therapy led to the disappearance of pericardial effusion and normalization of the activity of inflammatory markers in serum. However, in the dynamics of observation the attempt to suspend glucocorticoid therapy again led to fluid accumulation in the pericardium, which required continuation of steroidal and non-steroidal anti-inflammatory drugs.

Atrial and ventricular strain using cardiovascular magnetic resonance in the prediction of outcomes of pericarditis patients: a pilot study.

Our study aimed to explore with cardiovascular magnetic resonance (CMR) the impact of left atrial (LA) and left ventricular (LV) myocardial strain in patients with acute pericarditis and to investigate their possible prognostic significance in adverse outcomes. This retrospective study performed CMR scans in 36 consecutive patients with acute pericarditis (24 males, age 52 [23-52]). The primary endpoint was the combination of recurrent pericarditis, constrictive pericarditis, and surgery for pericardial diseases defined as pericardial events. Atrial and ventricular strain function were performed on conventional cine SSFP sequences. After a median follow-up time of 16months (interquartile range [13-24]), 12 patients with acute pericarditis reached the primary endpoint. In multivariable Cox regression analysis, LA reservoir and LA conduit strain parameters were all independent determinants of adverse pericardial diseases. Conversely, LV myocardial strain parameters did not remain an independent predictor of outcome. With receiving operating characteristics curve analysis, LA conduit and reservoir strain showed excellent predictive performance (area under the curve of 0.914 and 0.895, respectively) for outcome prediction at 12months. LA reservoir and conduit mechanisms on CMR are independently associated with a higher risk of adverse pericardial events. Including atrial strain parameters in the management of acute pericarditis may improve risk stratification. Atrial strain could be a suitable non-invasive and non-contrast cardiovascular magnetic resonance parameter for predicting adverse pericardial complications in patients with acute pericarditis. • Myocardial strain is a well-validated CMR parameter for risk stratification in cardiovascular diseases. • LA reservoir and conduit functions are significantly associated with adverse pericardial events. • Atrial strain may serve as an additional non-contrast CMR parameter for stratifying patients with acute pericarditis.

Novel therapeutic insights into the treatment of pericarditis: Targeting the innate immune system.

Acute pericarditis is characterized by pericardial inflammation which can be treated with anti-inflammatory drugs. A considerable percentage of patients develops recurrent pericarditis with several relapses. In developed countries, the idiopathic form is the most frequent and has a high risk of recurrences. Two pathophysiological mechanisms have been described for idiopathic recurrent pericarditis, autoimmune and autoinflammatory. The autoimmune mechanism is more frequently encountered in patients with rheumatologic disorders, especially systemic lupus erythematosus. The innate immune system plays a central role in the pathophysiology of pericarditis, especially in the autoinflammatory phenotype. Current evidence highlights the central role played by interleukin 1 (IL-1) and NLRP3 (NACHT, leucine-rich repeat, and pyrin domain-containing protein 3) in idiopathic recurrent pericarditis. Accordingly, IL-1 blockers have been approved for the treatment of this condition. Neutrophils are likely to be important in such setting, however their role has only been partially investigated. In the present review we have collected the current knowledge on the role of innate immune system in pericarditis pathophysiology and how this can be used to provide targeted treatments for patients with recurrent pericarditis.

Acute purulent pericarditis complicated by cardiac tamponade in a human immunodeficiency virus-positive patient.

Acute purulent pericarditis complicated by cardiac tamponade in a human immunodeficiency virus-positive patient.

Cardiac Involvement in Patients With Multisystem Inflammatory Syndrome in Adults.

Multisystemic inflammatory syndrome in adults is a hyperinflammatory condition following (within 4-12 weeks) SARS-CoV-2 infection. Here, the dysregulation of the immune system leads to a multiorgan involvement often affecting the heart. Cardiac involvement in multisystemic inflammatory syndrome in adults has been described mainly in young men without other comorbidities and may present with different clinical scenarios, including acute heart failure, life-threatening arrhythmias, pericarditis, and myocarditis, with a nonnegligible risk of mortality (up to 7% of all cases). The heterogeneity of its clinical features and the absence of a clear case definition make the differential diagnosis with other postinfectious (eg, infective myocarditis) and hyperinflammatory diseases (eg, adult Still disease and macrophage activation syndrome) challenging. Moreover, the evidence on the efficacy of specific treatments targeting the hyperinflammatory response underlying this clinical condition (eg, glucocorticoids, immunoglobulins, and other immunomodulatory agents) is sparse and not supported by randomized clinical trials. In this review article, we aim to provide an overview of the clinical features and the diagnostic workup of multisystemic inflammatory syndrome in adults with cardiac involvement, highlighting the possible pathogenetic mechanisms and the therapeutic management, along with remaining knowledge gaps in this field.

Interleukin-1 Blockers in Recurrent and Acute Pericarditis: State of the Art and Future Directions.

Diseases of the pericardium encompass a spectrum of conditions, including acute and recurrent pericarditis, where inflammation plays a pivotal role in the pathogenesis and clinical manifestations. Anti-inflammatory therapy indeed forms the cornerstone of treating these conditions: NSAIDs, colchicine, and corticosteroids (as a second-line treatment) are recommended by current guidelines. However, these medications come with several contraindications and are not devoid of adverse effects. In recent years, there has been an increased focus on the role of the inflammasome and potential therapeutic targets. Recurrent pericarditis also shares numerous characteristics with other autoinflammatory diseases, in which interleukin-1 antagonists have already been employed with good efficacy and safety. The objective of this review is to summarize the available studies on the use of anti-IL-1 drugs both in acute and recurrent pericarditis.

Efficacy and safety of colchicine for the treatment of myopericarditis

ObjectiveClinical trials have evaluated the efficacy and safety of colchicine only in simple pericarditis, excluding cases of concomitant myocarditis. The aim of this paper is to evaluate the efficacy and...

Kiosk 8R-TB-11 - The Utility of ECV Mapping in Acute Pericarditis

Kiosk 8R-TB-11 - The Utility of ECV Mapping in Acute Pericarditis

Особенности течения экссудативного перикардита при метастатическом поражении сердца

INTRODUCTION: Exudative pericarditis in a cancer patient is often a first manifestation of the disease and is considered a marker of a poor prognosis. According to the literature, the neoplastic etiology of a first-diagnosed exudative pericarditis is indicated by the following signs: cardiac tamponade, recurrent pericarditis, fever above 38°С, subacute course of pericarditis, absence of the effect of nonsteroidal anti-inflammatory drugs. The article presents a case report of cardiac metastasis in renal carcinoma manifested by acute exudative pericarditis in a 63-year old female patient. CONCLUSION: Diagnosis and treatment of cardiac metastasis presents difficulties in clinical practice due to the rarity of the disease, scarce symptoms, and the absence of clear recommendations for the management of such patients. Nevertheless, this rare route of metastasizing can significantly influence patient treatment and prognosis and requires cooperation between different specialists of the multidisciplinary team: oncologists, cardiologists, urologists (in case of renal cell carcinoma).

Misdiagnosis of Acute Pericarditis Presenting with Coronary Artery Disease: a Case Report

Pericarditis is a common disorder that might present in various settings, including primary-care and emergency department. However, the clinical features in some cases did not match with the written theory, which could lead to a misdiagnosis. We reported a 34-year-old female presented to the emergency room with progressive tightness chest pain in the past 3 days, that got worse with a change in position and penetrated to the back. Based on clinical chest pain with history of stable coronary artery disease, no changes electrocardiograph (ECG) and normal laboratory evaluation, the patient was diagnosed with NSTE-ACS, treated based on guideline therapy but did not showed clinical improvement. Clinical re-examination and echocardiography evaluation showed a pathognomonic finding of pericarditis feature. Combination therapy of colchicine was given for 3 months and aspirin for 2 weeks. Follow-up evaluation showed normal ECG and echocardiography result without any remainder symptoms. Acute pericarditis does not always show typical clinical findings. Therefore, clinician must always aware with other differential diagnosis of chest pain and ECG variation of acute pericarditis even though the patient has a history of coronary artery disease

Autophagy Activity in Epicardial Cells in Acute Pericarditis

Pericarditis is a group of polyetiological diseases often associated with emergence of life–threatening conditions. Poor knowledge of underlying cellular mechanisms and lack of relevant approaches to investigation of pericarditis result in major challenges in diagnosis and treatment.The aim of this work was to identify changes in the activity of autophagy in epicardial cells in acute pericarditis.Materials and methods. Acute pericarditis in mice was induced by intrapericardial injection of Freund's adjuvant in the study group (n=15). The control group included animals receiving either intrapericardial injection of phosphate-buffered saline (PBS) (n=15), or sham surgery without injections (n=7). On Days 3 or 5 after surgery the animals were euthanized under isoflurane anesthesia. Immunofluorescence staining of cardiac tissue cryo-sections and immunoblotting were used to assess the intensity of inflammation and autophagy in the epicardium.Results. Inflammation and other signs of acute pericarditis resulting in thickening of some epicardial areas were found: 68+9% in the control (after PBS injection) and 124+22% after Freund's adjuvant injection (p=0.009); other signs included cellular infiltration of epicardium and multiple adhesions. The epicardial layer exhibited signs of mesothelial cells reorganization with 11-fold increase of autophagy markers LC3 II/LC3 I ratio: 0.07+0.02 in the control group (after PBS injection) and 0.84+0.07 - in acute pericarditis (p=0.04), and accumulation of collagen fibers.Conclusion. Development of acute pericarditis is accompanied by activation of epicardial mesothelial cells, intensified autophagy and development of fibrous changes in epicacardial/ subepicardial areas.

Diabetes Mellitus and Peripartum Cardiomyopathy: A Nationwide Study

BackgroundThe relationship between diabetes mellitus-(DM) and peripartum-cardiomyopathy(PPCM) remains uncertain. This study aims to clarify the connection between DM and PPCM to predict cardiovascular-outcomes using data from the National Readmission Database(NRD). Methods and ResultsWe analyzed data from 2016-2020 and identified 20,865 hospitalizations for PPCM, with 10.02% (2,091 cases) of them diagnosed with DM. PPCM patients with DM had a higher mean age (36 years,SD-7.6 vs 32 years,SD-6.7;p=0.000). Baseline-comorbidities were shown in Figure1. DM in PPCM has been identified as a predictor for acute-kidney-injury(AKI)[OR 2.38,95%CI 2.01-2.82,p=0.000], and major-adverse-cardiac-and-cerebrovascular-events(MACCE)[OR 1.65,95%-CI 1.32-2.05,p=0.000]. However, it is not associated with an increased risk of death[OR 1.7,95%-CI 1.00-2.99,p=0.048],Stroke[OR 1.24,95%-CI 0.65-2.36,p=0.512],Myocardial infraction[OR 1.56,95%-CI 1.00-2.43,p = 0.051],Suddencardiac-arrest[OR 1.12,95%-CI 0.74-1.69,p=0.603), or the necessity for Mechanical-cardiac-support[OR 1.01,95%-CI 0.59-1.72, p=0.967], Figure-2. Moreover, PPCM patients with DM exhibit an extended mean hospital stay(7.2-vs-5.7 days,p<0.000) and infaltion adjusted-cost of hospitalization ($1,02,690-vs-$84,507,p<0.00). Interestingly, these patients had a lower 30-day non-elective readmission rate (2.3% vs. 8.9%). The top three primary causes of non-elective readmission in the DM group were heart-failure, acute pericarditis, and acute kidney injury. ConclusionsOur findings show that not only do PPCM patients with DM present a higher mean age and increased baseline comorbidities, but they are also at a greater risk for acute kidney injury and significant cardiac and cerebrovascular events. Additionally, these patients undergo extended average hospital stays and incur higher infaltion adjusted hospitalization expenses.

Comparative safety analysis of mRNA and adenoviral vector COVID-19 vaccines: a nationwide cohort study using an emulated target trial approach

ObjectiveThis nationwide cohort study compared the incidence of adverse events of special interest (AESIs) between adenoviral vector-based (ChAdOx1) and mRNA-based (BNT162b2 or mRNA-1273) coronavirus disease 2019 (COVID-19) vaccines. MethodsA targeted trial emulation study was conducted using data from the National Health Insurance Service database. Vaccinees aged 18–85 years who had received at least one dose of ChAdOx1 or an mRNA-based vaccine were identified. The 42-day risks of AESIs were calculated. ResultsA total of 1 767 539 ChAdOx1 vaccinees were matched exactly with mRNA vaccinees according to their risk factors. The 42-day risks of adverse events were low (∼0 to 176 events per 100 000 persons in both vaccine groups), and the incidence rates of AESIs were comparable between the two platforms, except for a higher occurrence of acute cardiac injury (incidence rate ratio [IRR], 1.22; 95% CI, 1.10–1.35), myocarditis or pericarditis (IRR, 2.14; 95% CI, 1.14–4.04), and arrhythmia (IRR, 1.46; 95% CI, 1.24–1.71) in mRNA vaccinees. The incidence of Guillain–Barré syndrome (IRR, 0.20; 95% CI, 0.06–0.69), vasovagal syncope (IRR, 0.77; 95% CI, 0.62–0.97), radiculopathy (IRR = 0.59, 95% CI, 0.41–0.84), and aseptic arthritis (IRR, 0.81; 95% CI, 0.70–0.93) was significantly lower in mRNA-based vaccinees compared with ChAdOx1 vaccinees. DiscussionA remarkable platform-dependent difference was observed in the safety profiles of COVID-19 vaccines, particularly for myocarditis or pericarditis and Guillain–Barré syndrome. However, the overall risk of AESIs was low for both vaccine platforms.

Pericarditis After Catheter Ablation for Atrial Fibrillation: Predictors and Outcomes

BackgroundCatheter ablation is a mainstay of atrial fibrillation (AF) treatment. Acute pericarditis after ablation is 1 of the frequently observed complications. There is a significant lack of data on the incidence and predictors of postablation pericarditis. ObjectivesThis study examines the incidence, characteristics, and predictors of pericarditis after AF ablation. MethodsPatients undergoing AF ablation from January 1, 2016, to March 31, 2022, at Johns Hopkins were prospectively enrolled in an AF ablation registry. A clinical diagnosis of acute pericarditis was established in accordance with 2015 European Society of Cardiology guidelines by the presence of at least 2 of the following characteristics: pleuritic chest pain, friction rub, typical electrocardiographic changes, or pericardial effusion within 3 months after the ablation procedure. ResultsOf 1,540 patients who underwent AF ablation, 57 patients (3.7%) developed acute pericarditis. Baseline clinical characteristics including age, sex, and body mass index were comparable between the pericarditis and nonpericarditis groups. The median time to symptom onset was 1 day. Electrocardiographic changes were observed in 34 (59.6%) patients, pericardial effusion developed in 7 (12%) patients, and the mean duration of medical treatment was 7 days (25th-75th percentile: 3-14 days). Most pericarditis cases were treated medically with disease-specific nonsteroidal anti-inflammatory drugs (100%) and colchicine (81%). Effusion with tamponade necessitating pericardiocentesis was observed in 4 (7%) patients. Radiofrequency (RF) ablation was performed in 869 (58.6%) patients in the nonpericarditis group and 39 (68.4%) patients with pericarditis; cryoballoon ablation was performed in 486 (32.8%) patients in the nonpericarditis group and 11 (19.3%) patients with pericarditis. Multivariable logistic regression analysis identified RF ablation (OR: 2.09; 95% CI: 1.07-4.08; P = 0.03) as an independent predictor of acute pericarditis after AF ablation, whereas age per unit increase was associated with a decreased risk (OR: 0.97; 95% CI: 0.95-0.995; P = 0.02). ConclusionsThe incidence of acute pericarditis after catheter ablation in our study population was 3.7%. RF ablation and younger age were independent risk factors for postablation acute pericarditis.

Surgically treated purulent pericarditis induced by ingested fish bone: a case report

BackgroundAspiration of fish bones is common, but perforation of the gastrointestinal tract is very rare. Once perforation occurs, fatal complications such as mediastinitis and cardiac tamponade can occur. Here, we present a case of acute pericarditis due to perforation of a fish bone.Case presentationA 66-year-old woman was referred to our hospital with shortness of breath. Blood tests showed high C-reactive protein, and contrast-enhanced computed tomography showed a large amount of pericardial fluid as well as a foreign body with high bone density in the pericardial sac. Upper gastrointestinal endoscopy showed no evidence of penetration of the esophageal or gastric mucosa. Emergency open chest surgery was performed, and the pericardial sac was filled with copious amounts of pus. The fish bone-like foreign body was found to penetrate the pericardial membrane from the diaphragmatic side. The foreign body was removed, a drainage tube was placed, and the chest was closed. After 2 weeks of postoperative antibiotics, the patient was discharged from the hospital in stable general condition. Three months after the surgery, the patient had no recurrence of pericarditis.ConclusionsWe reported a rare case of gastrointestinal perforation by a fish bone, resulting in pericardium, which was treated by surgical drainage.

Temporal trends of clinical outcomes in patients hospitalized with acute pericarditis: analysis of the nationwide database in Japan

Abstract Background Most patients with acute pericarditis are considered to have a good prognosis, but the short-term outcomes and whether they improve or worsen over time are unknown in large clinical databases. Purpose We sought to investigate in-hospital mortality and incidence of cardiac tamponade in patients hospitalized for acute pericarditis in Japan, as well as trends over time in these outcomes. Methods From the Japanese Registry of All Cardiac and Vascular Diseases database from 2016 to 2020, we analyzed 7,374 patients hospitalized for acute pericarditis at 871 certificated hospitals by Japanese Circulation Society. We included etiology of acute pericarditis by idiopathic, connective-tissue disease, and post-cardiac injury syndrome. The primary and secondary outcome was in-hospital mortality and incidence of cardiac tamponade, respectively. Cochran-Armitage test was performed. Results In Japanese acute pericarditis patients (mean age; 65.0 years, male 71.0%), the etiology was idiopathic 96.2%, connective-tissue disease 2.1%, and post-cardiac injury syndrome 1.7%. The mortality rate and incidence of cardiac tamponade were 2.2% and 5.3%, respectively. Secular trend in those rates remained unchanged over time (p-trend = 0.30 and 0.19). The rates of mortality and cardiac tamponade were 2.1% and 5.2% in idiopathic pericarditis, 1.3% and 10.5% in connective-tissue disease, and 7.0% and 3.9% in post-cardiac injury syndrome, respectively. Connective-tissue disease pericarditis was at higher risk of cardiac tamponade compared to idiopathic pericarditis (5.2 vs. 10.5%, P=0.004). In addition, compared to idiopathic pericarditis, postoperative cardiac pericarditis tended to have a higher mortality rate (2.1 vs. 7.0%, P&amp;lt;0.001). Conclusion The short-term prognosis of acute pericarditis did not change significantly over time. This finding that clinical outcomes differed depending on the underlying disease suggests to clinicians the importance of differential diagnosis.

D-dimers as a prognostic plasma biomarker in patients with a first episode of acute pericarditis

Abstract Introduction/Background At present the impact of plasma biomarkers in predicting outcome of patients with isolated acute pericarditis (AP) has been poorly investigated. Purpose This study aimed to investigate the prognostic role of fibrin d-dimers (DD), an easily obtainable biomarker, in patients with AP. Methods This is a prospective clinical study enrolling 265 consecutive patients hospitalized between September 2010 and May 2019 with a first episode of AP. At baseline demographics, clinical features, laboratory, imaging findings and treatment were recorded. All patients were followed-up for a minimum period of 18 months. DD measurement at presentation was at the discretion of the examining physician since their measurement is not performed as per protocol in patients with suspected AP. End-points included cardiac tamponade, new-onset atrial fibrillation, pericardial drainage, recurrent/constrictive pericarditis and death. Results DD were measured in 165 out of 265 patients (62.3%, median levels 1456 ng/ml) at presentation. Among them 121 patients (73.3%) presented with elevated age-adjusted DD levels. Patients with elevated DD compared to those without depicted a higher rate of pleural (69.4%, vs 38.6%, p&amp;lt;0.001) and pericardial effusions (89.3% vs 72.7%, p=0.009). Concerning baseline laboratory values, patients with elevated DD presented with lower hematocrit and higher platelet counts, admission and peak C-reactive protein levels, as well as serum Glutamic pyruvic transaminase (SGPT) (Figure 1). In terms of outcome patients with elevated DD depicted a trend towards a greater prevalence of pericardial tamponade vs those without (14.9% vs 4.5% respectively, p=0.07). No significant difference was observed in the remainder of the endpoints during a median follow-up of 51 months. Notably, 43.8% of patients with elevated DD underwent computed tomography pulmonary angiography (CTPA), with all of the examinations being negative for pulmonary embolism. Conclusion Elevated DD plasma values in AP patients is a marker of high inflammatory burden. A trend of this plasma biomarker elevation and in-hospital cardiac tamponade was also observed. DD elevation in AP patients should be interpreted with caution and should not prompt unnecessary investigations (such as CTPA).