Guidelines on the Diagnosis and Management of Pericardial Diseases Executive SummaryThe Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology

Abstract

Guidelines and Expert Consensus documents aim to present all the relevant evidence on a particular issue in order to help physicians to weigh the benefits and risks of a particular diagnostic or therapeutic procedure. They should be helpful in everyday clinical decision-making. A great number of Guidelines and Expert Consensus Documents have been issued in recent years by different organisations, the European Society of Cardiology (ESC) and by other related societies. By means of links to web sites of National Societies several hundred guidelines are available. This profusion can put at stake the authority and validity of guidelines, which can only be guaranteed if they have been developed by an unquestionable decision-making process. This is one of the reasons why the ESC and others have issued recommendations for formulating and issuing Guidelines and Expert Consensus Documents. In spite of the fact that standards for issuing good quality Guidelines and Expert Consensus Documents are well defined, recent surveys of Guidelines and Expert Consensus Documents published in peer-reviewed journals between 1985 and 1998 have shown that methodological standards were not complied within the vast majority of cases. It is therefore of great importance that guidelines and recommendations are presented in formats that are easily interpreted. Subsequently, their implementation programmes must also be well conducted. Attempts have been made to determine whether guidelines improve the quality of clinical practice and the utilisation of health resources. The ESC Committee for Practice Guidelines (CPG) supervises and coordinates the preparation of new Guidelines and Expert Consensus Documents produced by Task Forces, expert groups or consensus panels. The Committee is also responsible for the endorsement of these Guidelines and Expert Consensus Documents or statements. The strength of evidence related to a particular diagnostic or treatment option depends on the available data: (1) level of evidence A: multiple randomised clinical trials or meta-analyses; (2) level of evidence B: a single randomised trial or non-randomised studies; and (3) level of evidence C: consensus opinion of the experts. Indications for various tests and procedures were ranked in three classes: Conditions for which there is evidence and/or general agreement that a given procedure or treatment is useful and effective. Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment. Weight of evidence/opinion is in favour of usefulness/efficacy. Usefulness/efficacy is less well established by evidence/opinion. Conditions for which there is evidence and/or general agreement that the procedure/treatment is not useful/effective and in some cases may be harmful. The spectrum of pericardial diseases consists of congenital defects, pericarditis (dry, effusive, effusive-constrictive, and constrictive), neoplasm, and cysts. The aetiological classification comprises: infectious pericarditis, pericarditis in systemic autoimmune diseases, type 2 (auto) immune process, postmyocardial infarction syndrome, and auto-reactive (chronic) pericarditis (Table 1).1–3 Review of aetiology, incidence and pathogenesis of pericarditis1–3 CHF, congestive heart failure; DDg, differential diagnosis; MI, myocardial infarction; P., pericarditis; PE, pericardial effusion. Percentage related to the population of 260 subsequent patients undergoing pericardiocentesis, pericardioscopy and epicardial biopsy (Marburg pericarditis registry 1988–2001).1 Percentage related to the incidence of pericarditis in the specific population of patients (e.g., with systemic lupus erythematosus). Percentage related to the population of patients with neoplastic pericarditis. Review of aetiology, incidence and pathogenesis of pericarditis1–3 CHF, congestive heart failure; DDg, differential diagnosis; MI, myocardial infarction; P., pericarditis; PE, pericardial effusion. Percentage related to the population of 260 subsequent patients undergoing pericardiocentesis, pericardioscopy and epicardial biopsy (Marburg pericarditis registry 1988–2001).1 Percentage related to the incidence of pericarditis in the specific population of patients (e.g., with systemic lupus erythematosus). Percentage related to the population of patients with neoplastic pericarditis. Congenital defects of the pericardium (1/10.000 autopsies) comprise partial left (70%), right (17%) or total bilateral (rare) pericardial absence. Additional congenital abnormalities occur in ∼30% of patients.4 Most patients with a total pericardial absence are asymptomatic. Homolateral cardiac displacement and augmented heart mobility impose an increased risk for traumatic aortic dissection.5 Partial left side defects can be complicated by herniation and strangulation of the heart through the defect (chest pain, shortness of breath, syncope or sudden death). Surgical pericardioplas