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Hypothyroidism is a well-known cause of pericardial effusion (with an incidence of 3%–37%) and can cause cardiac tamponade in severe cases. In this review, we present the current knowledge on the epidemiology of hypothyroid-induced pericardial diseases, the mechanism through which low thyroid hormone levels affect the pericardium, the associated clinical manifestations, diagnostic tests and management options. Hypothyroidism causes pericardial effusion through increased permeability of the epicardial vessels and decreased lymphatic drainage of albumin, resulting in accumulation of fluid in the pericardial space. Interestingly, autoimmunity does not seem to play a major role in the pathophysiology, and a majority of effusions are asymptomatic due to slow fluid accumulation. The diagnosis is generally made when the pericardial disease is associated with an elevated thyroid-stimulating hormone level, and other secondary causes are excluded. Management consists of thyroid replacement therapy, along with pericardial drainage in case of tamponade.In conclusion, hypothyroidism-induced pericardial diseases are underdiagnosed. Initiating treatment early in the disease process and preventing complications relies on early diagnosis through systematic screening per guidelines.

ObjectivesRecurrences of pericarditis (RP) are often difficult to diagnose due to lack of clinical signs and symptoms during subsequent episodes. We aimed to investigate the value of quantitative assessment of pericardial delayed hyperenhancement (DHE) in diagnosing ongoing recurrences of pericarditis.MethodsQuantitative DHE was measured in 200 patients with established diagnosis of RP using cardiac MRI. Conventional clinical criteria for diagnosis of pericarditis were ≥2 of the following: chest pain, pericardial rub, ECG changes and new or worsening pericardial effusion.ResultsA total of 67 (34%) patients were identified as having ongoing episode of recurrence at the time of DHE measurements. In multivariable analysis, chest pain (OR: 10.9, pConclusionAmong patients with RP, quantitative DHE provided incremental information to diagnose ongoing recurrences over conventional clinical criteria of pericarditis. Quantitative DHE demonstrated acceptable test characteristics to diagnose ongoing recurrence even in RP patients presenting with chest pain.

Introduction Diastolic heart failure is the primary pathophysiologic manifestation of constrictive pericarditis. Pericardiectomy is the choice of treatment for patients who fail medical therapy. Constrictive pericarditis may be chronic or transient inflammatory or a combination of both. Medical therapy with anti-inflammatory drugs improves the pericardial inflammation in patients with increased delayed hyper-enhancement (DHE) on cardiac magnetic resonance (CMR) imaging. The evolution of constrictive physiology, heart failure manifestations and outcomes with such treatment need more study. Hypothesis We hypothesize that in inflammatory constrictive pericarditis, anti-inflammatory therapy may reduce the need for pericardiectomy by reducing inflammation and improving heart failure symptoms. We also hypothesize that patients with severe inflammation have the best response to medical therapy. Methods Consecutive patients diagnosed with constrictive pericarditis and pericardial inflammation as evidenced by their CMR and elevated inflammatory markers were included. Patients were treated as per standard of care with anti-inflammatory therapy and diuretics, and followed on an outpatient basis. CMR imaging was obtained at approximately 6 month intervals. Patients received pericardiectomy if they had persistent constrictive physiology and signs and symptoms of heart failure despite optimal therapy. Baseline characteristics, laboratory values, echocardiographic and CMR data were collected. Pericardial delayed hyper-enhancement was quantified by measuring the volume of DHE using an intensity cutoff of >6 SD above normal septal myocardium. Results A total of 44 patients with 123 CMRs were included. Pericardiectomy was performed in 19 patients. Mean age was 57.9 ± 14.5 years and 9 (28%) patients were female. Mean left ventricular ejection fraction was 59 ± 6.5 %. There were no significant baseline differences between patients who underwent pericardiectomy and those who did not. On mixed model logistic regression analysis, the odds of having constrictive physiology was reduced by 49% (95% CI: 14%–70%, P=0.011) per year of optimal medical therapy. Patients with DHE above median had a 69% lower risk of needing pericardiectomy (HR: 0.31, 95%CI: 0.10–0.95, P=0.039) (Figure. 1). Conclusions With optimal anti-inflammatory therapy, constrictive physiology resolves significantly over time. The risk of requiring pericardiectomy is lower in patients with higher pericardial delayed hyper-enhancement at baseline.