Constrictive Pericarditis Guidelines

Updated: Jan 01, 2020
  • Author: William M Edwards, Jr, MD; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
  • Print

Guidelines Summary

European Society of Cardiology (ESC)

The ESC released updated guidelines for the diagnosis and treatment of constrictive pericarditis in 2015, which are summarized below. [15]  All of these recommendations are based on class I, level C evidence, unless noted otherwise.

  • Transthoracic echocardiography as well as frontal and lateral chest radiography with adequate technical characteristics are recommended in all patients with suspected constrictive pericarditis.
  • Computed tomography (CT) scanning and/or cardiac magnetic resonance imaging (CMRI) are indicated as second-level imaging techniques to assess calcifications (CT scanning), pericardial thickness, and degree and extension of pericardial involvement.
  • Cardiac catheterization is indicated when noninvasive diagnostic methods do not provide a definite diagnosis of constriction.
  • The mainstay of treatment of chronic constriction is pericardiectomy.
  • Medical therapy for specific etiologies of pericarditis is recommended to prevent progression of constriction, as well as for advanced cases or in the setting of a high risk of surgery or mixed forms with myocardial involvement.
  • Empiric anti-inflammatory therapy may be considered in cases with transient or a new diagnosis of constriction with concomitant evidence of pericardial inflammation on CT/CMRI or results of laboratory studies suggestive of inflammation (eg, elevated C-reactive protein [CRP] or erythrocyte sedimentation rate [ESR]) (class IIb, level C evidence).