Diagnostic Yield of Extensive Infectious Panel Testing in Acute Pericarditis

Abstract

Objective: In an attempt to reconsider our local strategy, we evaluated patients with viral/idiopathic pericarditis in order to assess the diagnostic yield of our standard infectious panel, the characteristics of myocardial involvement, the utility of investigating myocardial involvement and the incidence of coronary evaluation tests. Methods: Seventy-six consecutive cases of idiopathic/viral acute pericarditis treated between March 2005 and March 2008 were retrospectively enrolled. Telephonic questionnaires were answered by all. Results: Myopericarditis was recorded in 45/71 (63.4%) consecutive patients. Sore throat on presentation (38 vs. 12%; p = 0.027) was the only symptom independently associated with myopericarditis. The following clinical features were significantly correlated with pericarditis rather than myopericarditis: age (42 ± 16 vs. 32 ± 12; p = 0.008), C-reactive protein (131 ± 75 vs. 78 ± 58; p = 0.009) and lower CPK and troponin levels (mean 96 vs. mean 489; p < 0.001 and mean 0 vs. mean 10; p < 0.001, respectively). The infectious panel revealed 6 positive results. After an average 3 years’ fol- low-up, recurrence was documented in 5 patients (7%). No patient initially regarded idiopathic developed systemic disease during follow-up. Conclusions: Among patients presenting with presumed idiopathic/viral pericarditis, myopericarditis is relatively common and has a benign evolution. Extensive serological investigation with a broad infectious panel proved to be diagnostically and therapeutically futile in our area.

2015 ESC Guidelines for the diagnosis and management of pericardial diseases

“…U wielu pacjentów przed pojawieniem się objawów zapalenia osierdzia i mięśnia sercowego (lub równocześnie z nimi) występują cechy ostrej choroby układu oddechowego (szczególnie ostre zapalenie migdałków lub zapalenie płuc) lub zapalenia przewodu pokarmowego. Zwiększona czułość oznaczania stężeń troponin i powszechna dostępność metody przyczyniły się do wzrostu liczby odnotowanych w piśmiennictwie przypadków [7,34,[66][67][68].…”

Diagnosis and treatment of pericarditis

“…Routine viral studies are no longer recommended, since the yield is low and serological evidence of a recent infection only suggests a recent viral infection with a probable correlation with pericarditis. Definite viral diagnosis would require a pericardial biopsy or pericardial fluid analyses that have no justification in an uncomplicated setting since the management and therapy is not altered and there is no demonstration that a specific antiviral therapy is needed in an immunocompetent patient with pericarditis 31 32…”

Study of etiological and clinical profile of pericardial effusion in a tertiary care hospital in Kosi region of Bihar, India

“…Most idiopathic cases are presumed to be of viral etiology, but testing for specific viruses is not routinely done because of the cost involved, low yield, and negligible impact on management. [5][6][7] In any case, the finding of cardiomegaly with clear lungs should raise the suspicion of a pericardial effusion. The echocardiogram is the most available and reliable technique in order to verify the presence and the amount of a pericardial effusion; in addition, the echocardiogram offers valuable data for evaluation of hemodynamic repercussion.…”