Constrictive Pericarditis and Effusive Constrictive Pericarditis: Is There a Role for Medical Therapy?

Constrictive pericarditis (CP) represents a spectrum of pericardial diseases characterized by impaired ventricular filling due to a noncompliant pericardium. Within this continuum, effusive constrictive pericarditis (ECP) and transient constrictive pericarditis are characterized by active inflammation. ECP combines pericardial effusion and constrictive physiology, whereas transient constrictive pericarditis is characterized by resolution, often after anti-inflammatory therapy. These conditions often result from idiopathic, post-surgical, autoimmune, or tuberculous causes and may progress from acute inflammation to chronic fibrosis and calcification, termed chronic constrictive pericarditis. Multimodality imaging, including echocardiography, cardiac magnetic resonance imaging, and cardiac computed tomography, plays a key role in establishing the diagnosis, assessing inflammation, and guiding treatment. In patients with active pericardial inflammation, increasing evidence and practice supports the early and combined initiation of anti-inflammatory therapy including nonsteroidal agents, colchicine, corticosteroids, and interleukin-1 inhibitors to reverse constrictive pathophysiology.