Work

Investigating Pericarditis Diagnosis in a Tertiary Pericardial Center

Year: 2025

Type: article

Abstract: BACKGROUND: Pericarditis diagnosis can be challenging due to its nonspecific presentation, which may lead to frequent misdiagnosis. OBJECTIVES: In this study, the authors aimed to report the rate of misdiagnosed pericarditis and describe the characteristics of these patients. METHODS: Between September 2022 and September 2023, patients referred to the Pericardial Center with a diagnosis of pericarditis were enrolled in a prospective registry. Data were collected using a standardized history and physical examination template. Diagnosis was established according to the 2015 European Society of Cardiology guidelines. The prevalence of misdiagnosed pericarditis was calculated. Demographics, comorbidities, symptoms, laboratory results, and imaging were compared between the accurately diagnosed (group 1) and misdiagnosed pericarditis cohorts (group 2). RESULTS: A total of 170 patients were included; the mean age was 49.1 years. Thirty-five percent of patients were misdiagnosed. Demographics were similar in both groups. Significant differences were found between group 1 and group 2) in coronary artery disease (17.3% vs 5.0%, P = 0.02), valvular disease (23.6% vs 8.3%, P = 0.01), and atrial fibrillation (24.5% vs 6.7%, P < 0.01). Significant late gadolinium enhancement on magnetic resonance imaging, raised inflammatory markers, electrocardiogram changes, and specific pericardial pain were more common in the accurately diagnosed group (P < 0.05). COVID-19 infection was significantly higher in the misdiagnosed group (16.7% vs 6.4%, P < 0.05), whereas cardiac surgery was significantly lower (3.3% vs 18.2%, P < 0.05). CONCLUSIONS: Thirty-five percent of patients referred to the pericardial center are misdiagnosed with pericarditis. Inflammatory markers and late gadolinium enhancement on magnetic resonance imaging can help refine the diagnosis. COVID-19 infection is associated with higher rates of misdiagnosis.

Source: JACC Advances

DOI: 10.1016/j.jacadv.2025.102335