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European Heart Journal Advance Access published August 29, 2015 European Heart Journal ESC GUIDELINES doi:10.1093/eurheartj/ehv318 2015 ESC Guidelines for the diagnosis and management of pericardial diseases The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS) Downloaded from Authors/Task Force Members: Yehuda Adler* (Chairperson) (Israel), Philippe Charron* (Chairperson) (France), Massimo Imazio† (Italy), Luigi Badano (Italy), Gonzalo Baro´ n-Esquivias (Spain), Jan Bogaert (Belgium), Antonio Brucato http://eurheartj.oxfordjournals.org/ (Italy), Pascal Gueret (France), Karin Klingel (Germany), Christos Lionis (Greece), Bernhard Maisch (Germany), Bongani Mayosi (South Africa), Alain Pavie (France), Arsen D. Ristic´ (Serbia), Manel Sabate´ Tenas (Spain), Petar Seferovic (Serbia), Karl Swedberg (Sweden), and Witold Tomkowski (Poland) Document Reviewers: Stephan Achenbach (CPG Review Coordinator) (Germany), Stefan Agewall (CPG Review Coordinator) (Norway), Nawwar Al-Attar (UK), Juan Angel Ferrer (Spain), Michael Arad (Israel), Riccardo Asteggiano (Italy), He´ctor Bueno (Spain), Alida L. P. Caforio (Italy), Scipione Carerj (Italy), Claudio Ceconi (Italy), Arturo Evangelista (Spain), Frank Flachskampf (Sweden), George Giannakoulas (Greece), Stephan Gielen by guest on October 21, 2015 (Germany), Gilbert Habib (France), Philippe Kolh (Belgium), Ekaterini Lambrinou (Cyprus), Patrizio Lancellotti (Belgium), George Lazaros (Greece), Ales Linhart (Czech Republic), Philippe Meurin (France), Koen Nieman (The Netherlands), Massimo F. Piepoli (Italy), Susanna Price (UK), Jolien Roos-Hesselink (The Netherlands), * Corresponding authors: Yehuda Adler, Management, Sheba Medical Center, Tel Hashomer Hospital, City of Ramat-Gan, 5265601, Israel. Affiliated with Sackler Medical School, Tel Aviv University, Tel Aviv, Israel, Tel: +972 03 530 44 67, Fax: +972 03 530 5118, Email: [email protected]. Philippe Charron, Service de Cardiologie, Chu Ambroise Pare´, 9 av Charles de Gaulle, 92104 Boulogne Billancourt, France, Tel: +33149095543,Fax:+33142161364, Email: [email protected]. †Massimo Imazio: Coordinator, affiliation listed in the Appendix. ESC Committee for Practice Guidelines (CPG) and National Cardiac Societies document reviewers: listed in Appendix. a Representing the European Association for Cardio-Thoracic Surgery (EACTS). ESC entities having participated in the development of this document. ESC Associations: Acute Cardiovascular Care Association (ACCA), European Association for Cardiovascular Prevention and Rehabilitation (EACPR), European Association of Car- diovascular Imaging (EACVI), European Association of Percutaneous Cardiovascular Interventions (EAPCI), Heart Failure Association (HFA). ESC Councils: Council for Cardiology Practice (CCP), Council on Cardiovascular Nursing and Allied Professions (CCNAP), Council on Cardiovascular Primary Care (CCPC). ESC Working Groups: Cardiovascular Pharmacotherapy, Cardiovascular Surgery, Grown-up Congenital Heart Disease, Myocardial and Pericardial Diseases, Pulmonary Circulation and Right Ventricular Function, Valvular Heart Disease. The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC. Disclaimer: The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication. The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recom- mendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encour- aged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription. & The European Society of Cardiology 2015. All rights reserved. For permissions please email: [email protected]. Page 2 of 44 ESC Guidelines Franc¸ois Roubille (France), Frank Ruschitzka (Switzerland), Jaume Sagrista` Sauleda (Spain), Miguel Sousa-Uvaa (Portugal), Jens Uwe Voigt (Belgium), and Jose Luis Zamorano (Spain) The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines. ------------------------------------------------------------------------------------------------------------------------------------------------------ Keywords Guidelines † Aetiology † Constrictive pericarditis † Diagnosis † Myopericarditis † Pericardial effusion † Pericardiocentesis † Pericarditis † Pericardium † Prognosis † Tamponade † Therapy Table of Contents Abbreviations and acronyms . 3 4.1.6 Cardiac catheterization . 22 Preamble . 3 4.1.7 Multimodality imaging . 22 1. Introduction . 4 4.2 Proposal for a general diagnostic workup . 23 1.1 What is new in pericardial diseases? . 5 5. Specific aetiologies of pericardial syndromes . 24 Downloaded from 2. Epidemiology, aetiology and classification of pericardial 5.1 Viral pericarditis . 24 diseases . 5 5.1.2 Definition and clinical spectrum . 24 2.1 Epidemiology . 5 5.1.3 Pathogenesis . 25 2.2 Aetiology . 5 5.1.4 Diagnosis . 25 3. Pericardial syndromes . 5 5.1.5 Identification of viral nucleic acids . 26 http://eurheartj.oxfordjournals.org/ 3.1 Acute pericarditis . 5 5.1.6 Therapy . 26 3.1.1 Clinical management and therapy . 7 5.2 Bacterial pericarditis . 26 3.1.2 Prognosis . 9 5.2.1 Tuberculous pericarditis . 26 3.2 Incessant and chronic pericarditis . 9 5.2.1.1 Diagnosis . 27 3.3 Recurrent pericarditis . 9 5.2.1.2 Management . 27 3.3.1 Therapy . 9 5.2.2 Purulent pericarditis . 28 3.3.2 Prognosis . 12 5.2.2.1 Epidemiology . 28 3.4 Pericarditis associated with myocardial involvement 5.2.2.2 Diagnosis . 28 (myopericarditis) . 12 5.2.2.3 Management . 28 by guest on October 21, 2015 3.4.1 Definition and diagnosis . 12 5.3 Pericarditis in renal failure . 29 3.4.2 Management . 12 5.4 Pericardial involvement in systemic autoimmune and 3.4.3 Prognosis . 13 autoinflammatory diseases . 29 3.5 Pericardial effusion . 13 5.5 Post-cardiac injury syndromes . 30 3.5.1 Clinical presentation and diagnosis . 13 5.5.1 Definition and diagnosis . 30 3.5.2 Triage and management . 14 5.5.2 Management . 30 3.5.3 Therapy . 14 5.5.3 Prevention . 30 3.5.4 Prognosis and follow-up . 15 5.5.4 Prognosis . 30 3.6 Cardiac tamponade . 16 5.5.4.1 Post-myocardial infarction pericarditis . 30 3.7 Constrictive pericarditis . 17 5.5.4.2 Postoperative effusions . 31 3.7.1 Clinical presentation . 17 5.6 Traumatic pericardial effusion and haemopericardium . 31 3.7.2 Diagnosis . 17 5.7 Pericardial involvement in neoplastic disease . 32 3.7.3 Therapy . 17 5.8 Other forms of pericardial disease . 33 3.7.4 Specific forms . 18 5.8.1 Radiation pericarditis . 33 3.7.4.1 Transient constrictive pericarditis . 18 5.8.2 Chylopericardium . 34 3.7.4.2 Effusive-constrictive pericarditis . 19 5.8.3 Drug-related pericarditis and pericardial effusion . 34 3.7.4.3 Chronic constrictive pericarditis . 19 5.8.4 Pericardial effusion in metabolic and endocrine 4. Multimodality cardiovascular imaging and diagnostic work-up . 20 disorders . 34 4.1 Multimodality imaging . 20 5.8.5 Pericardial involvement in pulmonary arterial 4.1.1 Chest X-ray . 20 hypertension . 34 4.1.2 Echocardiography . 20 5.8.6 Pericardial cysts . 35 4.1.3 Computed tomography . 20 6. Age and gender issues in pericardial diseases . 35 4.1.4 Cardiac magnetic resonance . 20 6.1 Paediatric setting . 35 4.1.5 Nuclear medicine . 22 6.2 Pregnancy, lactation and reproductive issues . 35 ESC Guidelines Page 3 of 44 6.3 The elderly . 36 TRAPS tumour necrosis factor receptor-associated periodic 7. Interventional techniques and surgery . 36 syndrome 7.1 Pericardiocentesis and pericardial drainage . 36 TSH thyroid stimulating hormone 7.2 Pericardioscopy . 37 Tx treatment 7.3 Pericardial fluid analysis, pericardial and epicardial biopsy 37 uIFN-g unstimulated interferon-gamma 7.4 Intrapericardial treatment . 37 VEGF vascular endothelial growth factor
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