{
  "abstract": "Background Pericardium is considered electrically inert, but diffuse ST-elevation is an electrocardiographic marker of acute pericarditis. We hypothesised that ST-elevation in acute pericarditis may reflect underlying myocardial involvement. Accordingly, this study aimed to assess the association between ST-elevation and myocardial involvement in pericarditis patients and to further characterise the clinical features and long-term outcomes of myopericarditis compared with isolated pericarditis.Methods This longitudinal multicentre study included 351 pericarditis patients (328 recurrent; 180 females), 70/351 with myopericarditis, defined by troponin elevation and/or suggestive cardiac MRI.Results 121 patients had ST-elevation (34.5%); they were younger: 38 years (23–53) vs 47 (31–58) (median (IQR)) (p<0.001), more often male: 63.6% (77/121) vs 40.9% (94/230) (p<0.001) and had higher C reactive protein values: 92.0 (35–170) vs 58.4 mg/L (15.8–137.5) (median (IQR)) (p=0.002) and less frequent pericardial effusions: 71.1% (86/121) vs 83.5% (192/230) (p=0.004).Myocardial involvement was diagnosed in 70/351 (19.9%) patients, occurring more frequently among those with ST-elevation: 26.4% (32/121), compared with those without: 16.5% (38/230) (p=0.035). ST-elevation predicted myocardial involvement with an OR of 1.82 (95% CI 1.07 to 3.10). Compared with isolated pericarditis, patients with myopericarditis were more frequently male: 61.4% (43/70) vs 45.6% (128/281) (p=0.023) and had a higher prevalence of transient systolic dysfunction: 13.5% (7/52) vs 2.1% (3/141) (p=0.004). During follow-up, myopericarditis patients had a lower remission rate: 18.5% (12/65) vs 31.2% (82/263) (p=0.047) and a higher annual hospitalisation rate (median 0.5 vs 0.4/year, p=0.010), while recurrence rates and disease duration were similar. Treatment strategies, including use of corticosteroids and interleukin 1 blockers, were also comparable.Conclusions ST-segment elevation in acute pericarditis was associated with myocardial involvement, supporting the concept that the pericardium is electrically inert. Myopericarditis was associated with lower remission rates and slightly higher hospitalisation needs compared to isolated pericarditis, despite otherwise comparable recurrence rates and treatment strategies.",
  "authors": [
    {
      "affiliations": [
        "Department of Internal Medicine, Ospedale Luigi Sacco, Milan, Lombardy, Italy"
      ],
      "name": "Elisa Ceriani"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Fatebenefratelli and Ophthalmic Hospital, Milan, Lombardy, Italy"
      ],
      "name": "Silvia Berra"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Fatebenefratelli and Ophthalmic Hospital, Milan, Lombardy, Italy"
      ],
      "name": "Francesco Agozzino"
    },
    {
      "affiliations": [
        "Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy"
      ],
      "name": "Martina Ceriani"
    },
    {
      "affiliations": [
        "Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy"
      ],
      "name": "Lucia Ghisolfi"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy"
      ],
      "name": "Francesco Moda"
    },
    {
      "affiliations": [
        "Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Milan, Italy"
      ],
      "name": "Francesco Rubuano"
    },
    {
      "affiliations": [
        "Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy",
        "Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy"
      ],
      "name": "Ludovico Luca Sicignano"
    },
    {
      "affiliations": [
        "Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy",
        "Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy"
      ],
      "name": "Laura Gerardino"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Fatebenefratelli and Ophthalmic Hospital, Milan, Lombardy, Italy"
      ],
      "name": "Lucia Trotta"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Fatebenefratelli and Ophthalmic Hospital, Milan, Lombardy, Italy"
      ],
      "name": "Massimo Pancrazi"
    },
    {
      "affiliations": [
        "Cardiology Division, Hospital San Leopoldo Mandic, Merate, Lombardy, Italy"
      ],
      "name": "Caterina Chiara De Carlini"
    },
    {
      "affiliations": [
        "Internal Medicine, ASST Papa Giovanni XXIII, Bergamo, Lombardia, Italy"
      ],
      "name": "Silvia Maestroni"
    },
    {
      "affiliations": [
        "Internal Medicine, ASST Papa Giovanni XXIII, Bergamo, Lombardia, Italy"
      ],
      "name": "Davide Cumetti"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Fatebenefratelli and Ophthalmic Hospital, Milan, Lombardy, Italy"
      ],
      "name": "Luisa Carrozzo"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Fatebenefratelli and Ophthalmic Hospital, Milan, Lombardy, Italy"
      ],
      "name": "Francesca Casarin"
    },
    {
      "affiliations": [
        "Cardiothoracic Department, Santa Maria della Misericordia University Hospital, Udine, Friuli-Venezia Giulia, Italy"
      ],
      "name": "Valentino Collini"
    },
    {
      "affiliations": [
        "Cardiothoracic Department, Santa Maria della Misericordia University Hospital, Udine, Friuli-Venezia Giulia, Italy",
        "Department of Medicine, University of Udine, Udine, Italy"
      ],
      "name": "Massimo Imazio"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Fatebenefratelli and Ophthalmic Hospital, Milan, Lombardy, Italy",
        "Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy"
      ],
      "name": "Antonio Brucato"
    }
  ],
  "title": "ST-segment elevation in acute pericarditis and myocardial involvement: electrocardiographic and clinical profiling",
  "uid": "d7adf2c4-fdf2-543f-bcc6-71b22a2241f6"
}