1. Pericarditi, Miocarditi e CMP infiammatorie: cosa c’è di nuovo
Pericarditi, Miocarditi e CMP infiammatorie: cosa c’è di nuovo? Pericarditi
Massimo Imazio, MD, FESC
Dipartimento di Cardiologia
Ospedale Maria Vittoria, Torino

2. Pericardite
Medico di Guardia

3. Eziologia, Diagnosi

4. Imazio M, et al. Circulation. 2007;115:2739

5. “Everything may cause pericarditis…” Int J Clin Pract 2007; 61: 138
Imazio M et al. Future Cardiology 2007; 3: 623

6. Major infectious agents
Viral (most common: Echovirus and Coxsackievirus (usual), Influenza, EBV, CMV, Adenovirus, Varicella, Rubella, Mumps, HBV, HCV, HIV, Parvovirus B19 and Human Herpes Virus 6 (increasing reports);
Bacterial (most common: tuberculous (4-5%), Coxiella burnetii (5-7%?), other bacterial rare may include Pneumo-, Meningo-, Gonococcosis, Haemophilus, Staphylococci, Chlamydia, Mycoplasma, Legionella, Leptospira, Listeria)
Fungal (rare: Histoplasma more likely in immunocompetent patients, Aspergillosis, Blastomycosis, Candida more likely in immunosuppressed host)
Parasitary (very rare: Echinococcus, Toxoplasma)
SYSTEMATIC BATTERY OF SEROLOGICAL TESTS
Levy PY et al.Future MIcrobiol 2006; 1(2):229

7. Acute pericarditis: etiology
Imazio M, et al. Circulation. 2007;115:2739
Imazio M, Trinchero R. Future Cardiology 2007; 3: 623

10. Triage in acute pericarditis

15. Diagnostic criteria
Imazio M, Trinchero R. J Cardiovasc Med 2007; 8: 404

16. Etiologic screening

19. Am J Cardiol 2007; 99:

23. Pathogenesis of recurrences
Imazio M, Trinchero R. Future Cardiology 2007; 3: 623

24. Etiology of recurrent pericarditis

25. Terapia

26. ASA o FANS Aspirina 2-4g/die Ibuprofene 1200-1800mg/die Indometacina
Nimesulide
200mg/die
Imazio M et al. J Cardiovasc Med 2007; 8: 748

27. Corticosteroidi come FR per le recidive
Imazio M, Trinchero R Rec Prog Med 2006; 98(5):265-70
Imazio M, et al. Circulation. 2007;115:2739

28. Effetti collaterali gravi Recidive Ricoveri
Prednisone
Effetti collaterali gravi
Recidive
Ricoveri
1mg/Kg/die
25% ++
mg/Kg/die
<10% +
Nature Cardiovasc Med 2008; in press

29. Cleve Clin J Med 2007; 74: 385-6

30. COPE: COlchicine for acute PEricarditis
NNT= 5
Corticosteroid therapy:
Recurrences
OR 4.30
95% CI 1.21 to 15.25; p=0.024
Here we can see the main results of the study. The primary end point was the recurrence rate. Colchicine reduced the recurrence rate at 18 months down to 11% and was also able to reduce the symptoms persistence at 72 hours as it can be observed in pts with a gouty attack. Drug withdrawal was recorded in about 8% of cases due to diarrhea. Thus in this study we need to treat 5 pts with colchicine in order to prevent 1 recurrence. In multivariate analysis, corticosteroid therapy was an independent risk factor for recurrences.
Drug withdrawal
Imazio M et al. Circulation 2005; 112(13):

31. Colchicina e recidive
Imazio M, Trinchero R Rec Prog Med 2006; 98(5):265-70

32. Colchicina e storia naturale della pericardite recidivante
Attack rate
Rec/pt/month
Brucato A et al. Clin Exp Rheumatol. 2006;24(1): 45-50

33. Colchicine: How does it work?
Imazio M, Trinchero R. Future Cardiology 2007; 3: 623

34. Imazio M, Trinchero R. Future Cardiology 2007; 3: 623

35. Colchicina e pericardite: Trials in corso
Imazio M et al. JCM 2007; Dic; 8(12):1044-8
Imazio M et al. JCM 2007; Oct;8(10):830-4
Imazio M et al. JCM 2007; Aug;8(8):613-7.

36. Clin Sci 2007; 113(11):443-8

37. JCM 2007; 8:

38. Prognosi

39. Am J Cardiol 2007; 100:1026

40. MOST CASES ARE BENIGN, TRIAGE FOR DECISION-MAKINGMD
on duty