[Acute pericarditis in the modern era: a diagnostic challenge]. / La péricardite aiguë en 2007: un défi diagnostique.

ABSTRACT

BACKGROUND: Diagnosis of acute pericarditis remains difficult in clinical practice. OBJECTIVES: The purpose of this study was to evaluate the clinical and biological features of patients presenting with acute pericarditis, and to determine the incidence and significance of troponin I (cTnI) elevation in that context. PATIENTS AND METHODS: We retrospectively included 55 patients with acute idiopathic pericarditis. We analyzed clinical presentation, ECG recordings, biologic results, echocardiography findings and cTnI level. RESULTS: Fifty-five consecutive patients (41 men, 54+/-18 years) with idiopathic acute pericarditis were included. There was a typical chest pain in 90% of cases, whereas fever and pericardial friction rub were present in 25 and 18%, respectively. ST-segment elevation was observed in 58% of the patients. A rise of cTnI and C-reactive protein was detectable in 27 and 78% of cases respectively. The following characteristics were more frequently associated with a positive cTnI test younger patients, recent infection and higher length-of-stay. Pericardial effusion was observed in 58% of patients. Cardiac tamponade and ventricular tachycardia both occurred in 3 patients (5%). After a mean follow-up of 33 months, recurrent pericarditis occurred in 13% of patients. A similar rate of complications was found in patients with a positive or a negative cTnI. CONCLUSION: Clinical spectra of acute pericarditis have changed and some classic assumptions and descriptions, perpetuated in some publications, are outdated. Clinical presentation implies a 45-55 year-old man, with a chest pain and ST-segment elevation, without fever or pericardial friction rub, and a positive cTnI test in 27% of cases. Therefore, misinterpretation as other disease, especially acute myocardial infarction, is common and diagnosis of acute pericarditis remains often retrospective. In our series, a cTnI rise did not appear as a negative prognostic marker.