Pericarditis laboratory studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Varun Kumar, M.B.B.S. Homa Najafi, M.D.[2]

Overview

Non-specific markers of inflammation are generally elevated in pericarditis. These include the leukocyte count, C-reactive protein, and ESR. The cardiac troponin is elevated if there is an injury to the underlying myocardium, a condition termed as myopericarditis. Diagnostic pericardiocentesis and biopsy help in identifying an underlying infectious or malignant process.

Inflammatory Markers

The following inflammatory markers are often elevated:

• CBC: Significant leukocytosis may be present.
• C-reactive protein
• Erythrocyte sedimentation rate (ESR)

Cardiac Biomarkers

The following markers of myonecrosis may be elevated if there is involvement of the underlying myocardium:

• Creatine kinase: Acute pericarditis may be associated with a modest increase in serum creatine kinase-MB (CK-MB) depending upon the extent of involvement of the underlying myocardium.
• Cardiac troponin-I (cTnI): The troponin can be elevated if there is an underlying myositis, or a myopericarditis. In Europe, patients with pericarditis and an elevated troponin are hospitalized briefly to assure that the patient is stable.
• LDH: Serum LDH may be elevated depending upon the extent of myocardial involvement.
• Serum myoglobin
• SGOT (AST)

Autoimmune Markers

Following autoimmune markers may be checked in patients with recurrent or prolonged pericarditis:

• Antistreptolysin O titre
• Rheumatoid factor (RF)
• Antinuclear antibody (ANA)
• Anti-dsDNA antibody

2015 ESC Guidelines on the Diagnosis and Treatment of Pericarditis (DO NOT EDIT)

Recommendations for the general diagnostic work-up of pericardial diseases

Class I

1. In all cases of suspected pericardial disease a first diagnostic evaluation is recommended with: – auscultation – ECG – transthoracic echocardiography – chest X-ray – routine blood tests, including markers of inflammation (i.e., CRP and/or ESR), white blood cell count with differential count, renal function and liver tests and myocardial lesion tests (CK, troponins). 2. CT and/or CMR are recommended as second-level testing for diagnostic workup in pericarditis. 3. Pericardiocentesis or surgical drainage are indicated for cardiac tamponade or suspected bacterial and neoplastic pericarditis. 4. Further testing is indicated in high-risk patients (defined as above) according to the clinical conditions. (Level of Evidence: C)

Class I

It is recommended to search for independent predictors of an identifiable and specifically treatable cause of pericarditis (i.e. bacterial, neoplastic, systemic inflammatory diseases). Major factors include: – fever >38 C – subacute course (symptoms developing over several days or weeks) – large pericardial effusion (diastolic echo-free space >20 mm in width) – cardiac tamponade – failure of Aspirin or NSAIDs (Level of Evidence: B)

Class IIb

Percutaneous or surgical pericardial biopsy may be considered in selected cases of suspected neoplastic or tuberculous pericarditis. (Level of Evidence: C)

Recommendations for diagnosis of acute pericarditis

Class I

1. ECG is recommended in all patients with suspected acute pericarditis. 2. Transthoracic echocardiography is recommended in all patients with suspected acute pericarditis. 3. Chest X-ray is recommended in all patients with suspected acute pericarditis. 4. Assessment of markers of inflammation (i.e. CRP) and myocardial injury (i.e. CK, troponin) is recommended in patients with suspected acute pericarditis. (Level of Evidence: C)

Recommendations for the diagnosis and therapy of viral pericarditis

Class IIa

For the definited diagnosis of viral pericarditis, a comprehensive workup of histological, cytological, immunohistological and molecular investigations in pericardial fluid and peri-/epicardial biopsies should be considered. (Level of Evidence: C)

Class III

1. Routine viral serology is not recommended, with the possible exception of HIV and HCV. 2. Corticosteroid therapy is not recommended in viral pericarditis. (Level of Evidence: C)

Recommendations for the diagnosis of purulent pericarditis

Class I

1. Urgent pericardiocentesis is recommended for the diagnosis of purulent pericarditis. 2. It is recommended that pericardial fluid be sent for bacterial, fungal and tuberculous studies and blood drawn for cultures. (Level of Evidence: C)