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

Pericardite Medico di Guardia

Eziologia, Diagnosi

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

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

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

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

Triage in acute pericarditis

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

Etiologic screening

Am J Cardiol 2007; 99: 1294-7

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

Etiology of recurrent pericarditis

Terapia

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

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

Effetti collaterali gravi Recidive Ricoveri Prednisone Effetti collaterali gravi Recidive Ricoveri 1mg/Kg/die 25% ++ 0.2-0.5mg/Kg/die <10% + Nature Cardiovasc Med 2008; in press

Cleve Clin J Med 2007; 74: 385-6

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):2012-6.

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

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

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

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

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.

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

JCM 2007; 8: 748-53

Prognosi

Am J Cardiol 2007; 100:1026

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