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Journal of Cardiovascular Medicine... Jun 2007Recurrent pericarditis is one of the most troublesome complications of acute pericarditis and, despite recent advances, remains one of the most challenging problems in... (Review)
Review
Recurrent pericarditis is one of the most troublesome complications of acute pericarditis and, despite recent advances, remains one of the most challenging problems in pericardial diseases. The exact recurrence rate is unknown, but a reasonable estimate is 30%. The diagnosis is based on clinical criteria, and only routine laboratory testing is required. In many, probably most cases, this is an autoimmune disease, but sometimes it is caused by reactivation of viral pericarditis, an unrelated infection, or is provoked by corticosteroid therapy. Therapeutic modalities are non-specific and varied, and usually the etiology is autoimmunity. Non-steroidal anti-inflammatory drugs with the possible addition of colchicine are the best first-choice treatment, before steroid therapy is tried. Corticosteroid therapy is an independent risk factor for recurrences. In order to provide an evidence-based clinical approach to management, we performed a systematic review of all publications on acute and recurrent pericarditis focusing on recent clinical trials.
Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents, Non-Steroidal; Colchicine; Humans; Pericardiectomy; Pericarditis; Prognosis; Risk Factors; Secondary Prevention
PubMed: 17502755
DOI: 10.2459/01.JCM.0000269708.72487.34 -
The Cochrane Database of Systematic... 2002Tuberculous pericarditis - tuberculosis infection of the pericardial membrane (pericardium) covering the heart - is becoming more common. The infection can result in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Tuberculous pericarditis - tuberculosis infection of the pericardial membrane (pericardium) covering the heart - is becoming more common. The infection can result in fluid around the heart or fibrosis of the pericardium, which can be fatal.
OBJECTIVES
In people with tuberculous pericarditis, to evaluate the effects on death, life-threatening conditions, and persistent disability of: (1) 6-month antituberculous drug regimens compared with regimens of 9 months or more; (2) corticosteroids; (3) pericardial drainage; and (4) pericardiectomy.
SEARCH STRATEGY
We searched the Cochrane Infectious Diseases Group trials register (June 2002), the Cochrane Controlled Trials Register (Issue 2, 2002), MEDLINE (1966 to June 2002), EMBASE (1980 to May 2002), and checked the reference lists of existing reviews. We also contacted organizations and individuals working in the field.
SELECTION CRITERIA
Randomized and quasi-randomized controlled trials of treatments for tuberculous pericarditis.
DATA COLLECTION AND ANALYSIS
Two reviewers independently assessed trial quality and extracted data. Meta-analysis using fixed effects models calculated summary statistics, provided there was no statistically significant heterogeneity, and expressed results as relative risk. Study authors were contacted for additional information.
MAIN RESULTS
Four trials met the inclusion criteria, with a total of 469 participants. Treatments tested were adjuvant steroids and surgical drainage. Two trials with a total of 383 participants tested adjuvant steroids in participants with suspected tuberculous pericarditis in the pre-HIV era. Fewer participants died in the intervention group, but numbers were small (relative risk [RR] 0.65; 95% confidence interval [CI] 0.36 to 1.16, n = 350). One small trial tested steroids in HIV positive participants with effusion showed a similar pattern (RR 0.50; 95% CI 0.19 to 1.28, n = 58). One trial examined open surgical drainage compared with conservative management, and showed surgery relieved cardiac tamponade.
REVIEWER'S CONCLUSIONS
Steroids could have important clinical benefits, but the trials published to date are too small to demonstrate an effect. This requires large placebo controlled trials. Subgroup analysis could explore whether effusion or fibrosis modify the effects. Therapeutic pericardiocentesis under local anaesthesia and pericardiectomy also require further evaluation.
Topics: Adrenal Cortex Hormones; Antitubercular Agents; Drainage; Humans; Pericardiectomy; Pericarditis, Tuberculous; Pericardium; Randomized Controlled Trials as Topic
PubMed: 12519546
DOI: 10.1002/14651858.CD000526 -
The Cochrane Database of Systematic... 2000Tuberculous (TB) pericarditis is becoming more common. The infection can result in fluid around the heart, which can be fatal. (Review)
Review
BACKGROUND
Tuberculous (TB) pericarditis is becoming more common. The infection can result in fluid around the heart, which can be fatal.
OBJECTIVES
To evaluate evidence from trials about the effects of medical and surgical treatments for TB pericarditis on death and life-threatening conditions.
SEARCH STRATEGY
The Cochrane Infectious Diseases Group trials register, the Cochrane controlled trials register, Medline, Embase and reference lists of articles; contact with experts in the field.
SELECTION CRITERIA
Randomised and quasi-randomised trials of treatments for TB pericarditis.
DATA COLLECTION AND ANALYSIS
Two reviewers independently assessed trial quality and extracted data. Meta-analysis using fixed effects models calculated summary statistics, provided there was no significant heterogeneity, and expressed results as relative risk.
MAIN RESULTS
Three trials met the inclusion criteria, with a total of 411 participants. Treatments were adjuvant steroids and surgical drainage. Two small trials tested steroids. There were fewer deaths (all causes) in the intervention group, but the numbers were small and the result could have occurred by chance (relative risk [RR] 0.65, 95% confidence interval [CI] 0.36 to 1.16, n = 350). In one trial studying patients with effusion, "cure" was higher in the steroid group (alive and free of disability at 2 years (RR 0.69, 95% CI 0.29 to 0.80, n = 221). One trial examined open surgical drainage compared with conservative management, and showed no impact of surgery on death, but a protective effective against cadiac tamponade (RR 0.04, 95% CI 0.00 to 0.64).
REVIEWER'S CONCLUSIONS
Steroids have potentially large impacts on survival, but trials are too small to test this. We believe further placebo controlled trials of steroids are warranted, exploring whether the presence of effusion or fibrosis modifies effects. Surgical options also require further evaluation.
Topics: Adrenal Cortex Hormones; Antitubercular Agents; Drainage; Humans; Pericardiectomy; Pericarditis, Tuberculous; Pericardium
PubMed: 10796550
DOI: 10.1002/14651858.CD000526