Anticardiac Antibodies in Patients with Chronic Pericardial Effusion

Abstract

Objectives. Chronic pericardial effusion may be challenging in terms of diagnosis and treatment. Specific laboratory parameters predicting the frequency and severity of recurrences after initial drainage of pericardial effusion are lacking. Materials and Methods. Pericardial fluid (PF) and serum (SE) samples from 30 patients with chronic pericardial effusion (PE) who underwent pericardiocentesis and pericardioscopically guided pericardial biopsy were compared with SE and PF samples from 26 control patients. The levels of antimyolemmal (AMLA) and antifibrillary antibodies (AFA) in PE and SE from patients with pericardial effusion as well as PF and SE from controls were determined and compared. Results. AMLAs and AFAs in PF and SE were significantly higher in patients with chronic pericardial effusion than in the control group (AMLAs: p = 0,01 for PF and p = 0,004 for serum; AFAs: p < 0,001 for PF and p = 0,003 for serum). Patients with recurrence of PE within 3 months after pericardiocentesis had significantly higher levels of AMLAs in SE (p = 0,029) than patients without recurrence of PE. Conclusions. The identification of elevated anticardiac antibodies in PE and SE indicates increased immunological reactivity in chronic pericardial effusion. High titer serum levels of AMLAs also correlate with recurrence of pericardial effusion.

Recurrent pericarditis: an update on diagnosis and management

“…However, an auto-inflammatory response based on interleukin-1 (IL-1) overproduction might be hypotesized in patients presenting with a typical “inflammatory phenotype” (fever and C-reactive protein elevation). On the contrary, an auto-immune response based on type I interferon pathway, might be prevalent in patients with concurrent auto-immune systemic disease, presenting with a non-inflammatory phenotype [ 38 , 64 – 66 ] . A third clinical phenotype includes patients with subacute presentation and mild increase of inflammation markers, without autoimmune manifestations [67] .…”

Advances in Imaging and Targeted Therapies for Recurrent Pericarditis

“…On the contrary, an autoimmune hypothesis based on molecular mimicry and production of autoantibodies may be responsible for the noninflammatory phenotype of recurrent pericarditis, which can be seen in patients with concurrent autoimmune systemic disease. [26][27][28]…”

“…This is important from the treatment point of view, as it advocates for the use of IL-1 blockers as targeted therapies for patients. On the contrary, an autoimmune hypothesis based on molecular mimicry and production of autoantibodies may be responsible for the noninflammatory phenotype of recurrent pericarditis, which can be seen in patients with concurrent autoimmune systemic disease …”