RESUMEN
Pericardial diseases have gained renewed clinical interest, leading to a renaissance in the field. There have been many recent advances in pericardial diseases in both multimodality cardiac imaging of diagnoses, such as recurrent, transient constrictive and effusive-constrictive pericarditis, and targeted therapeutics, especially anti-interleukin (IL)-1 agents that affect the inflammasome as part of autoinflammatory pathophysiology. There remains a large educational gap for clinicians, leading to variability in evaluation and management of these patients. The latest pericardial imaging (American Society of Echocardiography, European Association of Cardiovascular Imaging) and clinical guidelines (European Society of Cardiology) are >8-10 years of age and may not reflect current practice. Recent clinical trials involving anti-IL-1 agents in recurrent pericarditis, including anakinra (AIRTRIP), rilonacept (RHAPSODY), and goflikicept have demonstrated their efficacy. The present document represents an international position statement from world leaders in the pericardial field, focusing on novel concepts and emphasizing the role of multimodality cardiac imaging as well as new therapeutics in pericardial diseases.
Asunto(s)
Consenso , Imagen Multimodal , Pericardio , Valor Predictivo de las Pruebas , Humanos , Imagen Multimodal/normas , Pericardio/diagnóstico por imagen , Difusión de Innovaciones , Pronóstico , Pericarditis/diagnóstico por imagen , Pericarditis/terapia , Pericarditis/fisiopatología , Pericarditis/tratamiento farmacológico , Pericarditis Constrictiva/diagnóstico por imagen , Pericarditis Constrictiva/fisiopatología , Pericarditis Constrictiva/terapia , Técnicas de Imagen Cardíaca/normasAsunto(s)
Fibrilación Atrial , Dolor en el Pecho , Staphylococcus aureus Resistente a Meticilina , Pericarditis , Infecciones Estafilocócicas , Abuso de Sustancias por Vía Intravenosa , Anciano , Humanos , Masculino , Enfermedad Aguda , Antibacterianos/uso terapéutico , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/etiología , Fibrilación Atrial/terapia , Dolor en el Pecho/etiología , Dolor en el Pecho/terapia , Diagnóstico Diferencial , Ecocardiografía , Electrocardiografía , Fentanilo , Trastornos Inducidos por Narcóticos/complicaciones , Líquido Pericárdico/microbiología , Pericardiocentesis , Pericarditis/diagnóstico , Pericarditis/microbiología , Pericarditis/terapia , Pericarditis Constrictiva , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/terapia , Abuso de Sustancias por Vía Intravenosa/complicaciones , Supuración/microbiología , Supuración/terapia , Personas con Mala Vivienda , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hepatitis B Crónica/complicaciones , Hepatitis B Crónica/tratamiento farmacológico , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológicoAsunto(s)
Fibrilación Atrial , Ablación por Catéter , Pericarditis , Humanos , Fibrilación Atrial/cirugía , Fibrilación Atrial/epidemiología , Fibrilación Atrial/diagnóstico , Pericarditis/epidemiología , Pericarditis/etiología , Pericarditis/terapia , Masculino , Femenino , Incidencia , Persona de Mediana Edad , Enfermedad Aguda , Ablación por Catéter/efectos adversos , Anciano , Resultado del Tratamiento , Factores de Riesgo , Estudios RetrospectivosRESUMEN
In addition to conventional chemoradiation and targeted cancer therapy, the use of immune based therapies, specifically immune checkpoint inhibitors (ICIs) and chimeric antigen receptor T cell therapy (CAR-T), has increased exponentially across a wide spectrum of cancers. This has been paralleled by recognition of off-target immune related adverse events that can affect almost any organ system including the cardiovascular system. The use of ICIs has been associated with myocarditis, a less common but highly fatal adverse effect, pericarditis and pericardial effusions, vasculitis, thromboembolism, and potentially accelerated atherosclerosis. CAR-T resulting in a systemic cytokine release syndrome has been associated with myriad cardiovascular consequences including arrhythmias, myocardial infarction, and heart failure. This review summarizes the current state of knowledge regarding adverse cardiovascular effects associated with ICIs and CAR-T.
Asunto(s)
Inhibidores de Puntos de Control Inmunológico , Inmunoterapia Adoptiva , Neoplasias , Humanos , Neoplasias/tratamiento farmacológico , Neoplasias/terapia , Inhibidores de Puntos de Control Inmunológico/efectos adversos , Inmunoterapia Adoptiva/efectos adversos , Inmunoterapia Adoptiva/métodos , Enfermedades Cardiovasculares/inducido químicamente , Cardiotoxicidad/etiología , Miocarditis/inducido químicamente , Miocarditis/terapia , Síndrome de Liberación de Citoquinas/etiología , Pericarditis/inducido químicamente , Pericarditis/terapiaRESUMEN
INTRODUCTION: Purulent pericarditis secondary to esophago-pericardial fistula is a serious complication that has been previously reported in patients with esophageal cancer treated with radio/chemotherapy and esophageal stenting. However, the presence of esophago-pericardial fistula as the first manifestation of advanced carcinoma of the esophagus is exceedingly infrequent. We report the case of a 61-year-old male who presented with sepsis, cardiac tamponade and septic shock who was found to have an esophago-pericardial fistula secondary to squamous carcinoma of the esophagus. Emergency pericardiocentesis was performed with subsequent hemodynamic improvement. The drained pericardial fluid was purulent in nature and cultures were positive for Streptococcus anginosus. A CT scan followed by upper gastrointestinal endoscopy with tissue biopsy confirmed the diagnosis of squamous cell carcinoma of the esophagus. A self-expanding covered stent was endoscopically placed to exclude the fistula and restore the esophageal lumen. In this report, we discuss some aspects related to the diagnosis and management of this serious clinical entity.
Asunto(s)
Carcinoma de Células Escamosas , Fístula Esofágica , Neoplasias Esofágicas , Pericarditis , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/complicaciones , Pericarditis/microbiología , Pericarditis/etiología , Pericarditis/terapia , Pericarditis/diagnóstico , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/diagnóstico , Fístula Esofágica/etiología , Fístula Esofágica/diagnóstico , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/diagnóstico , Streptococcus anginosus/aislamiento & purificación , Pericardiocentesis , Stents , Tomografía Computarizada por Rayos X , Taponamiento Cardíaco/etiologíaRESUMEN
Inflammatory disease of the pericardium represents a relatively common presentation, especially among the young. For the most part, inflammatory pericardial disease can be expeditiously and effectively managed without significant sequelae. However, some individuals present with severe and recurrent illness, representing significant therapeutic challenges. During the past decade, there have been great strides made in developing an evidence-based approach to management of inflammatory pericardial disease, the result of which has been the development of (1) a systematic, protocoled approach to initial care; (2) targeted therapeutics; and (3) specialized, collaborative, and integrated care pathways. Herein we present a review of the current state of the art as it pertains to the diagnostic evaluation and therapeutic considerations in inflammatory pericardial disease with a focus on acute and complicated pericarditis.
Asunto(s)
Pericarditis , Humanos , Pericarditis/diagnóstico , Pericarditis/terapia , Pericarditis/etiología , Enfermedad AgudaRESUMEN
Acute pericarditis is defined as inflammation of the pericardium and occurs in approximately 4.4% of patients who present to the emergency department for nonischemic chest pain, with a higher prevalence in men. Although there are numerous etiologies of pericarditis, most episodes are idiopathic and the cause is presumed to be viral. Diagnosis of pericarditis requires at least two of the following criteria: new or worsening pericardial effusion, characteristic pleuritic chest pain, pericardial friction rub, or electrocardiographic changes, including new, widespread ST elevations or PR depressions. Pericardial friction rubs are highly specific but transient, and they have been reported in 18% to 84% of patients with acute pericarditis. Classic electrocardiographic findings include PR-segment depressions; diffuse, concave, upward ST-segment elevations without reciprocal changes; and T-wave inversions. Transthoracic echocardiography should be performed in all patients with acute pericarditis to characterize the size of effusions and evaluate for complications. Nonsteroidal anti-inflammatory drugs are the first-line treatment option. Glucocorticoids should be reserved for patients with contraindications to first-line therapy and those who are pregnant beyond 20 weeks' gestation or have other systemic inflammatory conditions. Colchicine should be used in combination with first- or second-line treatments to reduce the risk of recurrence. Patients with a higher risk of complications should be admitted to the hospital for further workup and treatment.
Asunto(s)
Antiinflamatorios no Esteroideos , Electrocardiografía , Pericarditis , Humanos , Pericarditis/diagnóstico , Pericarditis/fisiopatología , Pericarditis/terapia , Enfermedad Aguda , Antiinflamatorios no Esteroideos/uso terapéutico , Colchicina/uso terapéutico , Ecocardiografía , Femenino , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/terapia , Derrame Pericárdico/etiología , Dolor en el Pecho/etiología , Dolor en el Pecho/diagnóstico , Masculino , Glucocorticoides/uso terapéuticoRESUMEN
Medical therapy of pericarditis should be targeted at its aetiology. Unfortunately, many cases of pericarditis remain idiopathic after a complete diagnostic workup. In such cases, empiric anti-inflammatory therapy for pericarditis is aimed at controlling symptoms and preventing recurrences. The aim of the present clinical review is to summarize published evidence, guidelines, and to provide tips and tricks for clinical management of acute and recurrent pericarditis.
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Pericarditis , Humanos , Pericarditis/tratamiento farmacológico , Pericarditis/terapia , Pericarditis/diagnóstico , Antiinflamatorios/uso terapéutico , Recurrencia , Guías de Práctica Clínica como Asunto , Resultado del Tratamiento , Prevención Secundaria/métodosRESUMEN
A 55-year-old male with acute pericarditis presented with low-pressure cardiac tamponade (LPCT) unresponsive to volume infusion. Subsequent pericardiocentesis resulted in hemodynamic improvement and unmasking of pericardial constriction. This case provides illustrative hemodynamic tracings of LPCT. Additionally, the presence of concurrent pericardial constriction that may indicate a plausible underlying mechanism for the blunted responsiveness to fluid expansion in LPCT. The underlying physiologic processes and the associated hemodynamic tracings are discussed.
Asunto(s)
Taponamiento Cardíaco , Hemodinámica , Pericardiocentesis , Humanos , Taponamiento Cardíaco/fisiopatología , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/diagnóstico por imagen , Taponamiento Cardíaco/cirugía , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Pericarditis/fisiopatología , Pericarditis/terapia , Pericarditis/diagnóstico por imagen , Pericarditis/etiología , Pericarditis/diagnóstico , Enfermedad AgudaRESUMEN
Pericarditis typically presents with classic symptoms of acute sharp, retrosternal, and pleuritic chest pain. It can have several different underlying causes including viral, bacterial, and autoimmune etiologies. The mainstays of pericarditis treatment are nonsteroidal anti-inflammatory drugs and colchicine with glucocorticoids or other immunosuppressive drugs used for refractory cases and relapse. Myocarditis is an inflammatory disease of the cardiac muscle that is caused by a variety of infectious and noninfectious conditions. It mainly affects young adults (median age 30-45 years), and men more than women. The clinical manifestations of myocarditis are highly variable, so a high level of suspicion in the early stage of disease is important to facilitate diagnosis. The treatment of myocarditis includes nonspecific treatment aimed at complications such as heart failure and arrhythmia, as well as specific treatment aimed at underlying causes. Pericarditis and myocarditis associated with vaccine have been extremely rare before coronavirus disease 2019 (COVID-19). There is a small increase of incidence after COVID-19 messenger ribonucleic acid vaccine, but the relative risk for pericarditis and myocarditis due to severe acute respiratory syndrome coronavirus 2 infection is much higher. Therefore, vaccination against COVID-19 is currently recommended for everyone aged 6 years and older.
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COVID-19 , Miocarditis , Pericarditis , Masculino , Adulto Joven , Humanos , Femenino , Adulto , Persona de Mediana Edad , Miocarditis/diagnóstico , Miocarditis/terapia , Afecto , Vacunas contra la COVID-19 , Pericarditis/diagnóstico , Pericarditis/terapia , VacunaciónRESUMEN
Mpox, a novel epidemic disease, has broken out the period of coronavirus disease 2019 since May 2022, which was caused by the mpox virus. Up to 12 September 2023, there are more than 90,439 confirmed mpox cases in over 115 countries all over the world. Moreover, the outbreak of mpox in 2022 was verified to be Clade II rather than Clade I. Highlighting the significance of this finding, a growing body of literature suggests that mpox may lead to a series of cardiovascular complications, including myocarditis and pericarditis. It is indeed crucial to acquire more knowledge about mpox from a perspective from the clinical cardiologist. In this review, we would discuss the epidemiological characteristics and primary treatments of mpox to attempt to provide a framework for cardiovascular physicians.
Asunto(s)
COVID-19 , Enfermedades Cardiovasculares , Mpox , Miocarditis , Pericarditis , Humanos , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , COVID-19/epidemiología , Pericarditis/epidemiología , Pericarditis/etiología , Pericarditis/terapiaRESUMEN
A description of a COVID-19 patient with the development of exudative pericarditis complicated by cardiac tamponade is provid. A peculiarity of this case is the presence of an underlying disease in the patient (chronic lymphocytic leukemia), which was in remission for 1.5 years after chemotherapy. Another feature of the patient was the relatively small area of lung damage and the hemorrhagic nature of the pericardial effusion, which persisted for a long time. The insignificant activity of inflammatory markers was noteworthy. Possible mechanisms of development and features of the course of exudative pericarditis in the described patient, issues of diagnosis and treatment of this category of patients are discusse.
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COVID-19 , Taponamiento Cardíaco , Derrame Pericárdico , Pericarditis , Humanos , COVID-19/complicaciones , COVID-19/diagnóstico , Pericarditis/diagnóstico , Pericarditis/etiología , Pericarditis/terapia , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiología , Derrame Pericárdico/terapia , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/terapiaRESUMEN
Pericarditis and myocarditis represent a challenging set of diseases to diagnose and treat. These diseases typically present with chest pain and dyspnea in previously healthy young people, often in the weeks following a viral illness, including COVID-19. Nonetheless, the etiologies can be very diverse, including infectious, noninfectious, drug-induced, and autoimmune causes. This review focuses on the evaluation, diagnosis, and management of emergency department patients presenting with pericarditis and myocarditis and summarizes current guidelines and best-practice medical management strategies in order to avoid potential life-threatening cardiac complications.
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COVID-19 , Miocarditis , Pericarditis , Humanos , Adolescente , Miocarditis/diagnóstico , Miocarditis/terapia , Miocarditis/etiología , COVID-19/terapia , Pericarditis/diagnóstico , Pericarditis/terapia , Pericarditis/etiología , Servicio de Urgencia en Hospital , Diagnóstico Diferencial , Prueba de COVID-19RESUMEN
We present a case of a 54-year-old gentleman with a history of hypertension and chronic HIV who presented with fever and epigastric pain, found to have elevated troponin-I levels and diffuse ST-segement elevations on ECG without clinical evidence of ischemia concerning for myopericarditis. Initial laboratory findings also included thrombocytopenia and elevated aminotransferases as well as computed tomography imaging revealing splenic infarcts. Given plausible exposure to ticks, this led to the eventual diagnosis of anaplasmosis confirmed on PCR assay. Cardiac MRI images confirmed myocardial involvement, which resolved with antibiotic treatment. While rare, cardiac involvement is possible sequelae of anaplasmosis infection as illustrated by this case.
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Anaplasmosis , Miocarditis , Pericarditis , Masculino , Animales , Humanos , Persona de Mediana Edad , Anaplasmosis/complicaciones , Anaplasmosis/diagnóstico , Pericarditis/diagnóstico , Pericarditis/etiología , Pericarditis/terapia , Miocarditis/diagnóstico , Miocarditis/etiología , Miocarditis/terapia , Troponina IRESUMEN
BACKGROUND: Post cardiac injury syndrome (PCIS) is characterized by the development of pericarditis with or without pericardial effusion due to a recent cardiac injury. The relatively low incidence makes diagnosis of PCIS after implantation of a pacemaker easily be overlooked or underestimated. This report describes one typical case of PCIS. CASE PRESENTATION: We present a case report of a 94-year-old male with a history of sick sinus syndrome managed with a dual-chamber pacemaker who presented with PCIS after two months of pacemaker implantation. He gradually developed chest discomfort, weakness, tachycardia and paroxysmal nocturnal dyspnea and cardiac tamponade after two months of pacemaker. Post-cardiac injury syndrome related to dual-chamber pacemaker implantation was considered based on exclusion of other possible causes of pericarditis. His therapy was drainage of pericardial fluid and managed with a combination of colchicine and support therapy. He was placed on long-term colchicine therapy to prevent any recurrences. CONCLUSION: This case illustrated that PCIS can occur after minor myocardial injury, and that the possibility of PCIS should be considered if there is a history of possible cardiac insult.
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Taponamiento Cardíaco , Lesiones Cardíacas , Marcapaso Artificial , Derrame Pericárdico , Pericarditis , Masculino , Humanos , Anciano de 80 o más Años , Marcapaso Artificial/efectos adversos , Pericarditis/diagnóstico , Pericarditis/etiología , Pericarditis/terapia , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/etiología , Lesiones Cardíacas/terapia , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/etiología , Taponamiento Cardíaco/diagnóstico por imagen , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/terapiaRESUMEN
The causes of cardiac inflammation during the COVID-19 pandemic are manifold and complex, and may have changed with different virus variants and vaccinations. The underlying viral etiology is self-evident, but its role in the pathogenic process is diverse. The view of many pathologists that myocyte necrosis and cellular infiltrates are indispensable for myocarditis does not suffice and contradicts the clinical criteria of myocarditis, i.e., a combination of serological evidence of necrosis based on troponins or MRI features of necrosis, edema, and inflammation based on prolonged T1 and T2 times and late gadolinium enhancement. The definition of myocarditis is still debated by pathologists and clinicians. We have learned that myocarditis and pericarditis can be induced by the virus via different pathways of action such as direct viral damage to the myocardium through the ACE2 receptor. Indirect damage occurs via immunological effector organs such as the innate immune system by macrophages and cytokines, and then later the acquired immune system via T cells, overactive proinflammatory cytokines, and cardiac autoantibodies. Cardiovascular diseases lead to more severe courses of SARS-CoV2 disease. Thus, heart failure patients have a double risk for complicated courses and lethal outcome. So do patients with diabetes, hypertension, and renal insufficiency. Independent of the definition, myocarditis patients benefitted from intensive hospital care, ventilation, if needed, and cortisone treatment. Postvaccination myocarditis and pericarditis affect primarily young male patients after the second RNA vaccine. Both are rare events but severe enough to deserve our full attention, because treatment according to current guidelines is available and necessary.
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COVID-19 , Miocarditis , Pericarditis , Humanos , Masculino , SARS-CoV-2 , Autoinmunidad , Pandemias , Medios de Contraste , Gadolinio/uso terapéutico , Inflamación , Pericarditis/terapia , Arritmias Cardíacas , Citocinas , VacunaciónRESUMEN
Pericardial disease in the developing world is dominated primarily by effusive and constrictive syndromes and contributes to the acute and chronic heart failure burden in many regions. The confluence of geography (location in the tropics), a significant burden of diseases of poverty and neglect, and a significant contribution of communicable diseases to the general burden of disease is reflected in the wide etiological spectrum of causes of pericardial disease. The prevalence of Mycobacterium tuberculosis in particular, is high throughout much of the developing world where it is the most frequent and important cause of pericarditis and is associated with significant morbidity and mortality. Acute viral/idiopathic pericarditis, which is the primary manifestation of pericardial disease in the developed world is believed to occur significantly less frequently in the developing world. Although diagnostic approaches and criteria to establish the diagnosis of pericardial disease are similar throughout the globe, resource constraints such as access to multimodality imaging and hemodynamic assessment are a major limitation in much of the developing world. These important considerations significantly influence the diagnostic and treatment approaches, and outcomes related to pericardial disease.
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Insuficiencia Cardíaca , Miocarditis , Derrame Pericárdico , Pericarditis Constrictiva , Pericarditis , Humanos , Pericarditis Constrictiva/diagnóstico , Derrame Pericárdico/diagnóstico , Pericarditis/diagnóstico , Pericarditis/epidemiología , Pericarditis/terapia , Pericardio , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/etiología , Miocarditis/complicacionesRESUMEN
Pericardial effusion is the most common manifestation of pericardial diseases during pregnancy. This effusion is benign, mild, or moderate, well tolerated, with spontaneous resolution after delivery; no specific treatment is required. Acute pericarditis is the second most common condition, usually requiring medical therapy during pregnancy. Cardiac tamponade and constrictive pericarditis are rare in pregnancy. Pre-pregnancy counselling is essential in women of childbearing age with recurrent pericarditis to plan pregnancy in a phase of disease quiescence and to review therapy. High-dose aspirin or nonselective nonsteroidal anti-inflammatory drugs, such as ibuprofen and indomethacin, can be used up to the 20th week of gestation. Low-dose prednisone (2.5-10 mg/d) can be administered throughout pregnancy. All of these medications, apart from high-dose aspirin, may be used during lactation. Colchicine is compatible with pregnancy and breastfeeding, and it can be continued throughout pregnancy to prevent recurrences. Appropriate follow-up with a multidisciplinary team with experience in the field is recommended throughout pregnancy to ensure good maternal and fetal outcomes.
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Taponamiento Cardíaco , Derrame Pericárdico , Pericarditis Constrictiva , Pericarditis , Embarazo , Humanos , Femenino , Pericarditis/terapia , Pericarditis/tratamiento farmacológico , Aspirina/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéuticoRESUMEN
BACKGROUND: Acute pericarditis occasionally requires invasive treatment, and may recur after discharge. However, there are no studies on acute pericarditis in Japan, and its clinical characteristics and prognosis are unknown. METHODS: This was a single-center, retrospective cohort study of clinical characteristics, invasive procedures, mortality, and recurrence in patients with acute pericarditis hospitalized from 2010 to 2022. The primary in-hospital outcome was adverse events (AEs), a composite of all-cause mortality and cardiac tamponade. The primary outcome in the long-term analysis was hospitalization for recurrent pericarditis. RESULTS: The median age of all 65 patients was 65.0â¯years [interquartile range (IQR), 48.0-76.0â¯years], and 49 (75.3â¯%) were male. The etiology of acute pericarditis was idiopathic in 55 patients (84.6â¯%), collagenous in 5 (7.6â¯%), bacterial in 1 (1.5â¯%), malignant in 3 (4.6â¯%), and related to previous open-heart surgery in 1 (1.5â¯%). Of the 8 patients (12.3â¯%) with in-hospital AE, 1 (1.5â¯%) died during hospitalization and 7 (10.8â¯%) developed cardiac tamponade. Patients with AE were less likely to have chest pain (pâ¯=â¯0.011) but were more likely to have symptoms lasting 72â¯h after treatment (pâ¯=â¯0.006), heart failure (pâ¯<â¯0.001), and higher levels of C-reactive protein (pâ¯=â¯0.040) and B-type natriuretic peptide (pâ¯=â¯0.032). All patients complicated with cardiac tamponade were treated with pericardial drainage or pericardiotomy. We analyzed 57 patients for recurrent pericarditis after excluding 8 patients: 1 with in-hospital death, 3 with malignant pericarditis, 1 with bacterial pericarditis, and 3 lost to follow-up. During a median follow-up of 2.5â¯years (IQR 1.3-3.0â¯years), 6 patients (10.5â¯%) had recurrences requiring hospitalization. The recurrence rate of pericarditis was not associated with colchicine treatment or aspirin dose or titration. CONCLUSIONS: In acute pericarditis requiring hospitalization, in-hospital AE and recurrence were each observed in >10â¯% of patients. Further large studies on treatment are warranted.