ASE Expert Consensus Statement
American Society of Echocardiography Clinical Recommendations for Multimodality Cardiovascular Imaging of Patients with Pericardial Disease: Endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography

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Organization of the Writing Committee

The writing committee was made up of experts in pericardial diseases and imaging of the pericardium from the American Society of Echocardiography (ASE), the Society for Cardiovascular Magnetic Resonance Imaging, and the Society of Cardiovascular Computed Tomography. The document was reviewed by the ASE Guidelines and Standards Committee and official reviewers nominated by the Society for Cardiovascular Magnetic Resonance Imaging and the Society of Cardiovascular Computed Tomography.

The

Fibrous and Serosal Pericardium

The pericardium, a roughly flask-shaped sac that contains the heart, consists of a fibrous and a serosal component. The outer fibrous sac is composed primarily of collagen fibers with interspersed short elastic fibrils.15 The fibrous envelope is continuous with the adventitia of the great vessels superiorly and is attached to the central tendon of the diaphragm inferiorly. It is attached anteriorly to the sternum by sternopericardial ligaments. In the anteroinferior portion, the pericardium may

Future Techniques and Applications

The discussion of future techniques and applications in a guidelines report intended to provide a consensus of current imaging approaches to pericardial disease can only serve to make the reader aware of emerging trends, which may find their place in future recommendations.

Acute Pericarditis Key Points

  • 1.

    All patients with acute pericarditis should undergo TTE to assess for a PEff, tamponade physiology, and myocardial involvement.

    • a.

      In addition to echocardiography, CT and CMR should be considered when there are complexities associated with the clinical presentation of acute pericarditis, including

      • i.

        inconclusive echocardiographic findings and ongoing clinical concern;

      • ii.

        failure to respond promptly to anti-inflammatory therapy;

      • iii.

        atypical clinical presentation;

      • iv.

        suspicion of CP on the basis of clinical

Conclusions

In the modern era, multimodality imaging is essential in the diagnosis and management of pericardial syndromes. Echocardiography is the initial test for most pericardial syndromes, including acute pericarditis, recurrent pericarditis, and CP. CMR and CT can usually be added when there is complexity not handled by echocardiography or technically limited windows or when tissue characterization is needed, such as with edema and inflammation. In the future era of cost containment, clinical trials

Acknowledgments

We acknowledge the editorial assistance of Marie D. Campbell, the library assistance of Jodith Janes, and administrative assistance of Rhonda A. Price.

Notice and Disclaimer

This report is made available by the ASE, the Society for Cardiovascular Magnetic Resonance (SCMR), and the Society of Cardiovascular Computed Tomography (SCCT) as a courtesy reference source for their members. This report contains recommendations only and should not be used as the sole basis to make medical practice

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    The following authors reported no actual or potential conflicts of interest in relation to this document: Deborah A. Agler, RCT, RDCS, FASE, Christopher P. Appleton, MD, FASE, Judy Hung, MD, FASE, E. Rene Rodriguez, MD, Hartzell V. Schaff, MD, Paul Schoenhagen, MD, Carmela D. Tan, MD, and Richard D. White, MD. The following authors reported relationships with one or more commercial interests: Allan L. Klein, MD, FASE, receives honoraria for books from Elsevier and Lippincott Williams & Wilkins and serves on a multicenter trial steering committee for Bayer. Suhny Abbara, MD, serves as a consultant for Perceptive Informatics. Craig R. Asher, MD, coedited a book published by Lippincott Williams & Wilkins. Brian Hoit, MD, FASE, has served as a speaker for Philips Medical Systems. Mario J. Garcia, MD, receives royalties from Lippincott Williams & Wilkins and Elsevier and owns stock in Pfizer. Itzhak Kronzon, MD, FASE, has received an honorarium from Philips Medical Systems. Jae K. Oh, MD, FASE, has received a research grant from Toshiba and core laboratory funding from Medtronic.

    Reprint requests: American Society of Echocardiography, 2100 Gateway Centre Boulevard, Suite 310, Morrisville, NC 27560 (E-mail: [email protected]).

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