Cardiac magnetic resonance radiofrequency tissue tagging for diagnosis of constrictive pericarditis: A proof of concept study.
← Research streamAmong 120 referred patients, 39 were defined as constrictive pericarditis positive by radiofrequency tissue-tagging cardiac magnetic resonance. Of the 16 who underwent pericardiectomy, there was 100% agreement between cardiac magnetic resonance-defined positi…
Study snapshot
Abstract
OBJECTIVE: Invasive cardiac catheterization is the venerable "gold standard" for diagnosing constrictive pericarditis. However, its sensitivity and specificity vary dramatically from center to center. Given the ability to unequivocally define segments of the pericardium with the heart via radiofrequency tissue tagging, we hypothesize that cardiac magnetic resonance has the capability to be the new gold standard. METHODS: All patients who were referred for cardiac magnetic resonance evaluation of constrictive pericarditis underwent cardiac magnetic resonance radiofrequency tissue tagging to define visceral-parietal pericardial adherence to determine constriction. This was then compared with intraoperative surgical findings. Likewise, all preoperative cardiac catheterization testing was reviewed in a blinded manner. RESULTS: A total of 120 patients were referred for clinical suspicion of constrictive pericarditis. Thirty-nine patients were defined as constrictive pericarditis positive solely via radiofrequency tissue-tagging cardiac magnetic resonance, of whom 21 were positive, 4 were negative, and 1 was equivocal for constrictive pericarditis, as defined by cardiac catheterization. Of these patients, 16 underwent pericardiectomy and were surgically confirmed. There was 100% agreement between cardiac magnetic resonance-defined constrictive pericarditis positivity and postsurgical findings. No patients were misclassified by cardiac magnetic resonance. In regard to the remaining constrictive pericarditis-positive patients defined by cardiac magnetic resonance, 10 were treated medically, declined, were ineligible for surgery, or were lost to follow-up. Long-term follow-up of those who were constrictive pericarditis negative by cardiac magnetic resonance showed no early or late crossover to the surgery arm. CONCLUSIONS: Cardiac magnetic resonance via radiofrequency tissue tagging offers a unique, efficient, and effective manner of defining clinically and surgically relevant constrictive pericarditis. Specifically, no patient who was identified with constriction via cardiac magnetic resonance underwent inappropriate sternotomy. However, catheterization had substantial and unacceptable false-positive and false-negative rates with important clinical ramifications.
AI evidence extraction
Structured fields below were generated from the paper’s abstract and metadata to make the evidence easier to inspect. Automated extraction may be incomplete or incorrect; verify important details against the original paper.
Main findings
Among 120 referred patients, 39 were defined as constrictive pericarditis positive by radiofrequency tissue-tagging cardiac magnetic resonance. Of the 16 who underwent pericardiectomy, there was 100% agreement between cardiac magnetic resonance-defined positivity and postsurgical findings, and no patients were misclassified by cardiac magnetic resonance; cardiac catheterization showed false-positive and false-negative results.
Outcomes measured
- Diagnostic classification of constrictive pericarditis by cardiac magnetic resonance radiofrequency tissue tagging
- Comparison with intraoperative surgical findings (pericardiectomy confirmation)
- Comparison with preoperative cardiac catheterization findings (blinded review)
Limitations
- Proof-of-concept design
- Only a subset of cardiac magnetic resonance-positive patients underwent surgical confirmation (16/39)
- Some cardiac magnetic resonance-positive patients were treated medically, declined surgery, were ineligible, or were lost to follow-up
- Radiofrequency exposure parameters (e.g., frequency, SAR, duration) not reported
View raw extracted JSON
{
"study_type": "other",
"exposure": {
"band": null,
"source": "cardiac magnetic resonance (radiofrequency tissue tagging)",
"frequency_mhz": null,
"sar_wkg": null,
"duration": null
},
"population": "Patients referred for cardiac magnetic resonance evaluation for clinical suspicion of constrictive pericarditis",
"sample_size": 120,
"outcomes": [
"Diagnostic classification of constrictive pericarditis by cardiac magnetic resonance radiofrequency tissue tagging",
"Comparison with intraoperative surgical findings (pericardiectomy confirmation)",
"Comparison with preoperative cardiac catheterization findings (blinded review)"
],
"main_findings": "Among 120 referred patients, 39 were defined as constrictive pericarditis positive by radiofrequency tissue-tagging cardiac magnetic resonance. Of the 16 who underwent pericardiectomy, there was 100% agreement between cardiac magnetic resonance-defined positivity and postsurgical findings, and no patients were misclassified by cardiac magnetic resonance; cardiac catheterization showed false-positive and false-negative results.",
"effect_direction": "unclear",
"limitations": [
"Proof-of-concept design",
"Only a subset of cardiac magnetic resonance-positive patients underwent surgical confirmation (16/39)",
"Some cardiac magnetic resonance-positive patients were treated medically, declined surgery, were ineligible, or were lost to follow-up",
"Radiofrequency exposure parameters (e.g., frequency, SAR, duration) not reported"
],
"evidence_strength": "low",
"confidence": 0.74,
"peer_reviewed_likely": "yes",
"keywords": [
"cardiac magnetic resonance",
"radiofrequency tissue tagging",
"constrictive pericarditis",
"cardiac catheterization",
"pericardiectomy",
"diagnostic accuracy"
],
"suggested_hubs": []
}AI-extracted fields are generated from the abstract and metadata and may be incomplete or incorrect. This material is for informational purposes and is not medical advice.
Identifiers and source
DOI: 10.1016/j.jtcvs.2015.12.035
PubMed: 26818445