{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T11:19:39Z","timestamp":1783423179684,"version":"3.54.6"},"reference-count":52,"publisher":"IMR Press","issue":"6","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Cardiovasc. Med."],"abstract":"<jats:p>Pericardial diseases comprise a heterogeneous spectrum, ranging from self-limited acute pericarditis to recurrent inflammatory syndromes, large pericardial effusions, cardiac tamponade, and chronic constrictive pericarditis. Although acute pericarditis is often considered a benign condition, a substantial proportion of patients develop recurrent or persistent disease with prolonged symptoms and an impaired quality of life. Diagnostic uncertainty and suboptimal early management, particularly excessive corticosteroid use, may further contribute to the development of chronic disease and treatment resistance. Recent advances in cardiovascular imaging and anti-inflammatory therapy have substantially transformed the management of pericardial diseases. Multimodality imaging, including echocardiography, cardiac computed tomography (CT), and cardiac magnetic resonance (CMR) imaging, plays a central role in anatomical assessment, evaluation of hemodynamic impact, and differentiation of active inflammation from irreversible fibrotic remodeling. Meanwhile, an improved understanding of the autoinflammatory pathways involved in recurrent pericarditis has led to the development of targeted therapies, most notably interleukin -1 (IL-1) inhibitors, which have demonstrated robust efficacy and meaningful steroid-sparing effects in refractory disease. This review summarizes contemporary diagnostic and therapeutic strategies for pericardial diseases, with an emphasis on recurrent pericarditis and imaging-guided management. We propose a stepwise, precision-based approach that integrates clinical risk stratification, multimodality imaging, and targeted anti-inflammatory therapy to optimize patient outcomes.<\/jats:p>","DOI":"10.31083\/rcm50417","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T11:06:15Z","timestamp":1783422375000},"source":"Crossref","is-referenced-by-count":0,"title":["Pericardial Diseases in Cardiovascular Medicine: Contemporary Diagnosis, Risk Stratification, Multimodality Imaging, and Targeted Anti-Inflammatory Therapy"],"prefix":"10.31083","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3864-419X","authenticated-orcid":true,"given":"Bum Sung","family":"Kim","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Konkuk University Medical Center, 05030 Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4668-8229","authenticated-orcid":true,"given":"Ji-won","family":"Hwang","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Ilsan Paik Hospital, Inje University School of Medicine, 10380 Goyang, Gyeonggi-do, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Little WC, Freeman GL. Pericardial disease. Circulation. 2006; 113: 1622\u20131632.","DOI":"10.1161\/CIRCULATIONAHA.105.561514"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Maisch B, Seferovi\u0107 PM, Risti\u0107 AD, Erbel R, Rienm\u00fcller R, Adler Y, et al. Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. European Heart Journal. 2004; 25: 587\u2013610.","DOI":"10.1016\/j.ehj.2004.02.002"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Adler Y, Charron P, Imazio M, Badano L, Bar\u00f3n-Esquivias G, Bogaert J, et al. 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). European Heart Journal. 2015; 36: 2921\u20132964.","DOI":"10.1093\/eurheartj\/ehv318"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Wang TKM, Klein AL, Cremer PC, Imazio M, Kohnstamm S, Luis SA, et al. 2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on the Diagnosis and Management of Pericarditis: A Report of the American College of Cardiology Solution Set Oversight Committee. Journal of the American College of Cardiology. 2025; 86: 2691\u20132719.","DOI":"10.1016\/j.jacc.2025.05.023"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Schulz-Menger J, Collini V, Gr\u00f6schel J, Adler Y, Brucato A, Christian V, et al. 2025 ESC Guidelines for the management of myocarditis and pericarditis. European Heart Journal. 2025; 46: 3952\u20134041.","DOI":"10.1093\/eurheartj\/ehaf192"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Imazio M, Brucato A, Maestroni S, Cumetti D, Belli R, Trinchero R, et al. Risk of constrictive pericarditis after acute pericarditis. Circulation. 2011; 124: 1270\u20131275.","DOI":"10.1161\/CIRCULATIONAHA.111.018580"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Ling LH, Oh JK, Schaff HV, Danielson GK, Mahoney DW, Seward JB, et al. Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardiectomy. Circulation. 1999; 100: 1380\u20131386.","DOI":"10.1161\/01.cir.100.13.1380"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Bertog SC, Thambidorai SK, Parakh K, Schoenhagen P, Ozduran V, Houghtaling PL, et al. Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy. Journal of the American College of Cardiology. 2004; 43: 1445\u20131452.","DOI":"10.1016\/j.jacc.2003.11.048"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Chiabrando JG, Bonaventura A, Vecchi\u00e9 A, Wohlford GF, Mauro AG, Jordan JH, et al. Management of Acute and Recurrent Pericarditis: JACC State-of-the-Art Review. Journal of the American College of Cardiology. 2020; 75: 76\u201392.","DOI":"10.1016\/j.jacc.2019.11.021"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Malik AA, Lloyd JW, Anavekar NS, Luis SA. Acute and Complicated Inflammatory Pericarditis: A Guide to Contemporary Practice. Mayo Clinic Proceedings. 2024; 99: 795\u2013811.","DOI":"10.1016\/j.mayocp.2024.01.012"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Imazio M, Lazaros G, Brucato A, Gaita F. Recurrent pericarditis: new and emerging therapeutic options. Nature Reviews. Cardiology. 2016; 13: 99\u2013105.","DOI":"10.1038\/nrcardio.2015.115"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Al-Kazaz M, Klein AL, Oh JK, Crestanello JA, Cremer PC, Tong MZ, et al. Pericardial Diseases and Best Practices for Pericardiectomy: JACC State-of-the-Art Review. Journal of the American College of Cardiology. 2024; 84: 561\u2013580.","DOI":"10.1016\/j.jacc.2024.05.048"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Maestroni S, Di Corato PR, Cumetti D, Chiara DBLC, Ghidoni S, Prisacaru L, et al. Recurrent pericarditis: autoimmune or autoinflammatory? Autoimmunity Reviews. 2012; 12: 60\u201365.","DOI":"10.1016\/j.autrev.2012.07.023"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Buckley LF, Viscusi MM, Van Tassell BW, Abbate A. Interleukin-1 blockade for the treatment of pericarditis. European Heart Journal. Cardiovascular Pharmacotherapy. 2018; 4: 46\u201353.","DOI":"10.1093\/ehjcvp\/pvx018"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Klein AL, Imazio M, Cremer P, Brucato A, Abbate A, Fang F, et al. Phase 3 Trial of Interleukin-1 Trap Rilonacept in Recurrent Pericarditis. The New England Journal of Medicine. 2021; 384: 31\u201341.","DOI":"10.1056\/NEJMoa2027892"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Wang TKM, Klein AL. Rilonacept (Interleukin-1 Inhibition) for the Treatment of Pericarditis. Current Cardiology Reports. 2022; 24: 23\u201330.","DOI":"10.1007\/s11886-021-01621-0"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Welch TD, Oh JK. Constrictive pericarditis: old disease, new approaches. Current Cardiology Reports. 2015; 17: 20.","DOI":"10.1007\/s11886-015-0576-x"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Conte E, Agalbato C, Melotti E, Marchetti D, Schillaci M, Ratti A, et al. The Contemporary Role of Cardiac Computed Tomography and Cardiac Magnetic Resonance Imaging in the Diagnosis and Management of Pericardial Diseases. The Canadian Journal of Cardiology. 2023; 39: 1111\u20131120.","DOI":"10.1016\/j.cjca.2023.01.030"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Antonopoulos AS, Vrettos A, Androulakis E, Kamperou C, Vlachopoulos C, Tsioufis K, et al. Cardiac magnetic resonance imaging of pericardial diseases: a comprehensive guide. European Heart Journal. Cardiovascular Imaging. 2023; 24: 983\u2013998.","DOI":"10.1093\/ehjci\/jead092"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Klein AL, Wang TKM, Cremer PC, Abbate A, Adler Y, Asher C, et al. Pericardial Diseases: International Position Statement on New Concepts and Advances in Multimodality Cardiac Imaging. JACC. Cardiovascular Imaging. 2024; 17: 937\u2013988.","DOI":"10.1016\/j.jcmg.2024.04.010"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Brucato A, Imazio M, Gattorno M, Lazaros G, Maestroni S, Carraro M, et al. Effect of Anakinra on Recurrent Pericarditis Among Patients With Colchicine Resistance and Corticosteroid Dependence: The AIRTRIP Randomized Clinical Trial. JAMA. 2016; 316: 1906\u20131912.","DOI":"10.1001\/jama.2016.15826"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Imazio M, Gaita F, LeWinter M. Evaluation and Treatment of Pericarditis: A Systematic Review. JAMA. 2015; 314: 1498\u20131506.","DOI":"10.1001\/jama.2015.12763"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Mayosi BM, Burgess LJ, Doubell AF. Tuberculous pericarditis. Circulation. 2005; 112: 3608\u20133616.","DOI":"10.1161\/CIRCULATIONAHA.105.543066"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Fowler NO. Constrictive pericarditis: its history and current status. Clinical Cardiology. 1995; 18: 341\u2013350.","DOI":"10.1002\/clc.4960180610"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Cremer PC, Klein AL, Imazio M. Diagnosis, Risk Stratification, and Treatment of Pericarditis: A Review. JAMA. 2024; 332: 1090\u20131100.","DOI":"10.1001\/jama.2024.12935"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Malik J, Zaidi SMJ, Rana AS, Haider A, Tahir S. Post-cardiac injury syndrome: An evidence-based approach to diagnosis and treatment. American Heart Journal Plus : Cardiology Research and Practice. 2021; 12: 100068.","DOI":"10.1016\/j.ahjo.2021.100068"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Azarbal A, LeWinter MM. Pericardial Effusion. Cardiology Clinics. 2017; 35: 515\u2013524.","DOI":"10.1016\/j.ccl.2017.07.005"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Burazor I, Imazio M, Markel G, Adler Y. Malignant pericardial effusion. Cardiology. 2013; 124: 224\u2013232.","DOI":"10.1159\/000348559"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"Mudra SE, Rayes DL, Agrawal A, Kumar AK, Li JZ, Njus M, et al. Immune checkpoint inhibitors and pericardial disease: a systematic review. Cardio-oncology (London, England). 2024; 10: 29.","DOI":"10.1186\/s40959-024-00234-0"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Baker AE, Dani R, Smith ER, Tyberg JV, Belenkie I. Quantitative assessment of independent contributions of pericardium and septum to direct ventricular interaction. The American Journal of Physiology. 1998; 275: H476\u2013H483.","DOI":"10.1152\/ajpheart.1998.275.2.H476"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"Janicki JS, Weber KT. The pericardium and ventricular interaction, distensibility, and function. The American Journal of Physiology. 1980; 238: H494\u2013H503.","DOI":"10.1152\/ajpheart.1980.238.4.H494"},{"key":"ref32","doi-asserted-by":"publisher","unstructured":"Dinarello CA. Interleukin-1 in the pathogenesis and treatment of inflammatory diseases. Blood. 2011; 117: 3720\u20133732.","DOI":"10.1182\/blood-2010-07-273417"},{"key":"ref33","doi-asserted-by":"publisher","unstructured":"Feng D, Glockner J, Kim K, Martinez M, Syed IS, Araoz P, et al. Cardiac magnetic resonance imaging pericardial late gadolinium enhancement and elevated inflammatory markers can predict the reversibility of constrictive pericarditis after antiinflammatory medical therapy: a pilot study. Circulation. 2011; 124: 1830\u20131837.","DOI":"10.1161\/CIRCULATIONAHA.111.026070"},{"key":"ref34","doi-asserted-by":"publisher","unstructured":"Kafil TS, Wang TKM, Agrawal A, Majid M, Syed AB, Hutt E, et al. Advances in multi-modality imaging for constrictive pericarditis and pericardial inflammation: role of imaging-guided therapy. Expert Review of Cardiovascular Therapy. 2023; 21: 269\u2013279.","DOI":"10.1080\/14779072.2023.2187377"},{"key":"ref35","doi-asserted-by":"publisher","unstructured":"Spodick DH. Acute pericarditis: current concepts and practice. JAMA. 2003; 289: 1150\u20131153.","DOI":"10.1001\/jama.289.9.1150"},{"key":"ref36","doi-asserted-by":"publisher","unstructured":"Sagrist\u00e0-Sauleda J, Angel J, S\u00e1nchez A, Permanyer-Miralda G, Soler-Soler J. Effusive-constrictive pericarditis. The New England Journal of Medicine. 2004; 350: 469\u2013475.","DOI":"10.1056\/NEJMoa035630"},{"key":"ref37","doi-asserted-by":"publisher","unstructured":"Welch TD. Constrictive pericarditis: diagnosis, management and clinical outcomes. Heart (British Cardiac Society). 2018; 104: 725\u2013731.","DOI":"10.1136\/heartjnl-2017-311683"},{"key":"ref38","doi-asserted-by":"publisher","unstructured":"Spodick DH. Acute cardiac tamponade. The New England Journal of Medicine. 2003; 349: 684\u2013690.","DOI":"10.1056\/NEJMra022643"},{"key":"ref39","doi-asserted-by":"publisher","unstructured":"Sagrist\u00e0-Sauleda J, Angel J, Sambola A, Permanyer-Miralda G. Hemodynamic effects of volume expansion in patients with cardiac tamponade. Circulation. 2008; 117: 1545\u20131549.","DOI":"10.1161\/CIRCULATIONAHA.107.737841"},{"key":"ref40","doi-asserted-by":"publisher","unstructured":"Kearns MJ, Walley KR. Tamponade: Hemodynamic and Echocardiographic Diagnosis. Chest. 2018; 153: 1266\u20131275.","DOI":"10.1016\/j.chest.2017.11.003"},{"key":"ref41","doi-asserted-by":"publisher","unstructured":"Myers RB, Spodick DH. Constrictive pericarditis: clinical and pathophysiologic characteristics. American Heart Journal. 1999; 138: 219\u2013232.","DOI":"10.1016\/s0002-8703(99)70105-5"},{"key":"ref42","doi-asserted-by":"crossref","unstructured":"Chandraratna PA. Echocardiographic evaluation of pericardial disease. JAMA. 1983; 250: 2677\u20132680.","DOI":"10.1001\/jama.1983.03340190079040"},{"key":"ref43","doi-asserted-by":"publisher","unstructured":"Friedrich MG, Sechtem U, Schulz-Menger J, Holmvang G, Alakija P, Cooper LT, et al. Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. Journal of the American College of Cardiology. 2009; 53: 1475\u20131487.","DOI":"10.1016\/j.jacc.2009.02.007"},{"key":"ref44","doi-asserted-by":"publisher","unstructured":"Spodick DH. Diagnostic electrocardiographic sequences in acute pericarditis. Significance of PR segment and PR vector changes. Circulation. 1973; 48: 575\u2013580.","DOI":"10.1161\/01.cir.48.3.575"},{"key":"ref45","doi-asserted-by":"publisher","unstructured":"Imazio M, Brucato A, Cemin R, Ferrua S, Belli R, Maestroni S, et al. Colchicine for recurrent pericarditis (CORP): a randomized trial. Annals of Internal Medicine. 2011; 155: 409\u2013414.","DOI":"10.7326\/0003-4819-155-7-201110040-00359"},{"key":"ref46","doi-asserted-by":"publisher","unstructured":"Imazio M, Bobbio M, Cecchi E, Demarie D, Demichelis B, Pomari F, et al. Colchicine in addition to conventional therapy for acute pericarditis: results of the COlchicine for acute PEricarditis (COPE) trial. Circulation. 2005; 112: 2012\u20132016.","DOI":"10.1161\/CIRCULATIONAHA.105.542738"},{"key":"ref47","doi-asserted-by":"publisher","unstructured":"Imazio M. Treatment of recurrent pericarditis. Expert Review of Cardiovascular Therapy. 2012; 10: 1165\u20131172.","DOI":"10.1586\/erc.12.101"},{"key":"ref48","doi-asserted-by":"publisher","unstructured":"Klein A, Cremer P, Kontzias A, Furqan M, Forsythe A, Crotty C, et al. Clinical Burden and Unmet Need in Recurrent Pericarditis: A Systematic Literature Review. Cardiology in Review. 2022; 30: 59\u201369.","DOI":"10.1097\/CRD.0000000000000356"},{"key":"ref49","doi-asserted-by":"publisher","unstructured":"Miranda WR, Oh JK. Constrictive Pericarditis: A Practical Clinical Approach. Progress in Cardiovascular Diseases. 2017; 59: 369\u2013379.","DOI":"10.1016\/j.pcad.2016.12.008"},{"key":"ref50","doi-asserted-by":"publisher","unstructured":"Wu MA, Kessel C, Fadle N, Regitz E, Fuehner S, Negro E, et al. IL-1 Receptor Antagonist Antibodies in Idiopathic Recurrent Pericarditis. JAMA Network Open. 2025; 8: e2536691.","DOI":"10.1001\/jamanetworkopen.2025.36691"},{"key":"ref51","unstructured":"Arcalyst (rilonacept) [prescribing information]. B.K.P.U., Ltd: Hamilton. 2021."},{"key":"ref52","doi-asserted-by":"publisher","unstructured":"\u00d6zlek B, Tan\u0131k VO, Barut\u00e7u S. Inflammatory biomarkers in pericarditis: a comprehensive clinical review. Biomarkers in Medicine. 2025; 19: 1093\u20131106.","DOI":"10.1080\/17520363.2025.2590419"}],"container-title":["Reviews in Cardiovascular Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/27\/6\/10.31083\/RCM50417","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T11:07:40Z","timestamp":1783422460000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.imrpress.com\/journal\/RCM\/27\/6\/10.31083\/RCM50417"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,26]]},"references-count":52,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026]]}},"alternative-id":["S1530-6550(26)02366-5"],"URL":"https:\/\/doi.org\/10.31083\/rcm50417","relation":{},"ISSN":["1530-6550","2153-8174"],"issn-type":[{"value":"1530-6550","type":"print"},{"value":"2153-8174","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,26]]},"article-number":"50417"}}