Table 1
Established predictors of relapse in recurrent pericarditis. BNP: B-type natriuretic peptide; CMR: cardiac magnetic resonance; CRP: C-reactive protein; CT: computed tomography; ESR: erythrocyte sedimentation rate; IL-1: interleukin-1; LGE: late gadolinium enhancement; LVEF: left ventricular ejection fraction; NLR: neutrophil-to-lymphocyte ratio; NSAID: nonsteroidal anti-inflammatory drug; PIV: pan-immune-inflammatory value
| CLINICAL PREDICTORS | LABORATORY PREDICTORS | IMAGING PREDICTORS | TREATMENT-RELATED PREDICTORS |
|---|---|---|---|
| Fever > 100.4°F at presentation | Elevated baseline CRP | Persistent pericardial LGE on CMR | Early or high-dose corticosteroid use |
| Subacute or incessant disease course | Delayed CRP normalization after treatment initiation | Persistent pericardial T2 hyperintensity (edema) on CMR | Rapid tapering of NSAIDs or corticosteroids |
| Large pericardial effusion | Elevated ESR | Large or recurrent pericardial effusion on echocardiography | Absence, under-dosing, or early discontinuation of colchicine |
| Cardiac tamponade at presentation | Neutrophilia or lymphopenia | Constrictive physiology (echo or CMR features) | Inadequate duration of anti-inflammatory therapy |
| Younger age | Elevated NLR | Pericardial thickening or calcification on CT | Failure to escalate therapy in refractory disease |
| Female sex | Elevated PIV | Myocardial involvement (myopericarditis) on CMR | Delayed initiation of IL-1 inhibition when indicated |
| Autoimmune or autoinflammatory disease | Elevated cardiac troponin (myocardial involvement) | Reduced LVEF or regional wall motion abnormalities | Poor treatment adherence |
| Post–cardiac injury syndromes | Elevated BNP/NT-proBNP | Effusive-constrictive pericarditis | Failure to identify and treat underlying etiology |
Table 2
Contemporary risk scores for risk stratification in pericarditis. AUC: area under the receiver operating characteristic curve; CMR: cardiac magnetic resonance; CRP: C-reactive protein; DMARD: disease-modifying antirheumatic drug; late gadolinium enhancement; NSAID: nonsteroidal anti-inflammatory drug
| NAME OF SCORE | ATHENS RECURRENCE SCORE | TORINO PERICARDITIS SCORE | INFLA SCORE | KLEIN REMISSION SCORE |
|---|---|---|---|---|
| Author / Year | Lazarou et al., 2021 | Imazio et al., 2021 | Andreis et al., 2025 | Yesilyaprak et al., 2024 |
| Study population | ~240 patients; first episode acute pericarditis | ~500 patients; acute pericarditis at presentation | ~200 patients; suspected acute pericarditis presenting with chest pain | ~500 patients; recurrent or refractory pericarditis managed at tertiary center |
| Primary outcome predicted | Risk of pericarditis recurrence | Risk of complicated pericarditis (recurrence, tamponade, or constriction) | Diagnosis of pericarditis (inflammatory probability; indirect risk stratification) | Probability of achieving steroid-free clinical remission |
| Score parameters | Age; heart rate; platelet count; pericardial effusion size; inferior vena cava collapse; in-hospital corticosteroid use | Fever > 100.4°F; subacute/incessant course; large pericardial effusion; cardiac tamponade; NSAID non-response; immunosuppression | CRP; white blood cell count; neutrophil count; platelet count; chest pain characteristics | Age; sex; number of recurrences; autoimmune etiology; heart rate category; pericardial LGE severity on CMR; left ventricular ejection fraction; colchicine use; corticosteroid exposure; DMARD use |
| Performance (AUC / C-statistic) | C-index ≈ 0.74 for recurrence prediction | C-index ≈ 0.75–0.80 for complicated pericarditis | AUC ≈ 0.80 for pericarditis diagnosis | C-index ≈ 0.80 for remission prediction |