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Clinical research study
Etiology of Pericarditis in a Prospective Cohort of 1162 Cases

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Abstract

Background

Pericarditis is a common disorder that is present in various pathologies and may be the first manifestation of an underlying systemic disease. The aims of this study were to describe the different causes of infectious and noninfectious pericarditis and compare them with those in the literature.

Methods

Between May 2007 and September 2012, we prospectively evaluated a strategy using a systematic prescription of tests for the different etiological causes of pericarditis in patients with acute pericarditis who were hospitalized in the Cardiology and Cardiac Surgery Department or admitted to the Emergency Department (University Hospital of Marseille). A total of 1162 patients with suspected pericarditis were included. A standardized diagnosis procedure was performed for 800 patients, and 362 had pericardiocentesis.

Results

Acute pericarditis was diagnosed in 933 patients. No diagnosis was established in 516 patients (55%), 197 patients suffered from postinjury syndromes, and 156 had previously known diseases that were associated with pericarditis. Our survey allowed us to relate the probable cause of pericarditis in 64 cases. An infectious etiological diagnosis was established in 53 cases. In our study, postinjury syndrome was the leading cause of pericarditis, a new diagnosis was made in 6.7% of cases, and 16% of the diagnoses were linked to a secondary, underlying disease.

Conclusion

Using this strategy, we were able to reduce the number of idiopathic cases. In many cases, the etiologies were still identified. Long-term follow-up in the management of idiopathic pericarditis should remain of great interest for the future diagnosis of other disorders that remain hidden.

Section snippets

Patients

Between May 2007 and September 2012, all patients with acute pericarditis (with or without pericardial effusion) who were hospitalized in the Cardiology and Cardiac Surgery Department or admitted to the Emergency Department (University Hospital of Marseille) with the prescription of standardized procedure were included in our study (Figure 1). All patients who were admitted for acute pericarditis had physical examinations, an electrocardiogram, an echocardiogram, and biologic screening. A

Description of Patients

From May 2007 to September 2012, we received 1162 samples that were obtained from patients with suspected pericarditis. A noninvasive, standardized procedure diagnosis was performed for 800 patients, and only 362 had pericardiocentesis with an invasive standardized procedure diagnosis (Figure 2). Of the 800 patients, 151 who received a pericardial kit for the assessment of chest pain and 78 patients who suffered from myocarditis without pericarditis were excluded from the study. Of the

Discussion

To better understand and evaluate the etiological causes of pericarditis in our center, we conducted a prospective study for 6 years, and it included one of the largest series of patients with acute pericarditis who were diagnosed by either noninvasive or invasive procedures. With the addition of our previous reports of 204 patients who were diagnosed by noninvasive procedures4 and 106 patients who were diagnosed by a molecular analysis of their pericardial fluid,9 this was the largest series

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    Funding: None.

    Conflict of Interest: None.

    Authorship: All authors had access to the data and a role in writing the manuscript.

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