Journal of the American Society of Echocardiography
ASE Expert Consensus StatementAmerican 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
Section snippets
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
- i.
- a.
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
References (215)
- et al.
Pericardial disease: diagnosis and management
Mayo Clin Proc
(2010) - et al.
Pericarditis
Lancet
(2004) - et al.
Multimodality imaging of pericardial diseases
JACC Cardiovasc Imaging
(2010) - et al.
ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology
J Am Coll Cardiol
(2006) - et al.
ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance
J Cardiovasc Comput Tomogr
(2010) - et al.
Neglected cardiovascular diseases in Africa: challenges and opportunities
J Am Coll Cardiol
(2010) - et al.
Histologic and ultrastructural features of normal human parietal pericardium
Am J Cardiol
(1980) - et al.
Pericardial thickness measured with transesophageal echocardiography: feasibility and potential clinical usefulness
J Am Coll Cardiol
(1997) The normal pericardium
Am J Cardiol
(1970)- et al.
Pericardial delayed hyperenhancement with CMR imaging in patients with constrictive pericarditis undergoing surgical pericardiectomy: a case series with histopathological correlation
JACC Cardiovasc Imaging
(2011)
Pericardial diseases
Curr Probl Cardiol
Frequency and predictors of urgent coronary angiography in patients with acute pericarditis
Mayo Clin Proc
Evaluation of pericardial effusion with computed tomography
Am Heart J
A case of effusive-constructive pericarditis: an efficacy of GD-DTPA enhanced magnetic resonance imaging to detect a pericardial thickening
Magn Reson Imaging
Assessment of early post-infarction pericardial injury by CMR
JACC Cardiovasc Imaging
MR imaging of the pericardium
Magn Reson Imaging Clin N Am
Pericarditis in systemic diseases
Cardiol Clin
Primary acute pericardial disease: a prospective series of 231 consecutive patients
Am J Cardiol
Etiology of large pericardial effusions
Am J Med
Clinical clues to the causes of large pericardial effusions
Am J Med
Prevalence and correlates of posterior extra echocardiographic spaces in a free-living population based sample (the Framingham study)
Am J Cardiol
Two dimensional echocardiographic recognition of the descending thoracic aorta: value in differentiating pericardial from pleural effusions
Am J Cardiol
Combined posteroanterior subepicardial fat simulating the echocardiographic diagnosis of pericardial effusion
J Am Coll Cardiol
Localization of pericardial effusion with wide angle phased array echocardiography
Am J Cardiol
Usefulness of nuclear magnetic resonance imaging for evaluation of pericardial effusions, and comparison with two-dimensional echocardiography
Am J Cardiol
Imaging of pericardial disease
Magn Reson Imaging Clin N Am
Magnetic resonance imaging in acute and subacute mediastinal bleeding
Am Heart J
Previously unrecognized intrapericardial hematoma leading to refractory abdominal ascites
Chest
Massive pericardiac hematoma with severe constrictive pathophysiologic complications after insertion of an epicardial pacemaker
Am Heart J
Two-dimensional echocardiography in cardiac tamponade occurring after cardiac surgery
J Am Coll Cardiol
Postoperative cardiac tamponade in the modern surgical era
Ann Thorac Surg
Effects of positive-pressure ventilation, pericardial effusion, and cardiac tamponade on respiratory variation in transmitral flow velocities
J Cardiothorac Vasc Anesth
Colchicine in addition to conventional therapy for acute pericarditis: results of the Colchicine for Acute Pericarditis (COPE) trial
Circulation
Colchicine for Recurrent Pericarditis (CORP): a randomized trial
Ann Intern Med
Colchicine for the Prevention of the Post-Pericardiotomy Syndrome (COPPS): a multicentre, randomized, double-blind, placebo-controlled trial
Eur Heart J
Controversial issues in the management of pericardial diseases
Circulation
Guidelines on the diagnosis and management of pericardial diseases executive summary; the Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology
Eur Heart J
The role of multimodality imaging in the management of pericardial disease
Circ Cardiovasc Imaging
Pericardial disease: value of CT and MR imaging
Radiology
ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents
J Am Coll Cardiol
Anatomy of the pericardium
CT dimensions of the normal pericardium
Br J Radiol
MRI of the normal pericardium
AJR Am J Roentgenol
Cross-sectional anatomy of the pericardial sinuses, recesses, and adjacent structures
Surg Radiol Anat
CT of the pericardial recesses
AJR Am J Roentgenol
Prostaglandins in the pericardial fluid modulate neural regulation of cardiac electrophysiological properties
Circ Res
Potential paracrine role of the pericardium in the regulation of cardiac function
Cardiovasc Res
Mediastinal venography. Subselective transfemoral catheterization technique
Radiology
Pericardial influences on right and left ventricular filling dynamics
Circ Res
Acute cardiac tamponade
N Engl J Med
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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.
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