{"id":"d3121df968ff","type":"article","url":"https://hartvaat.nl/2026/03/18/st-elevatie-bij-acute-pericarditis-wijst-op-myocardiale-betrokkenheid/","title":"ST-elevatie bij acute pericarditis wijst op myocardiale betrokkenheid","title_en":"ST-segment elevation in acute pericarditis and myocardial involvement: electrocardiographic and clinical profiling","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-hartfalen","endocarditis","hartkatheterisatie","myocardinfarct","myocarditis","slaapapneu","stemi"],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e004019?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e004019?rss=1","authors":["Ceriani","E.","Berra","S.","Agozzino","F.","Ceriani","M.","Ghisolfi","L.","Moda","F.","Rubuano","F.","Sicignano","L. L.","Gerardino","L.","Trotta","L.","Pancrazi","M.","De Carlini","C. C.","Maestroni","S.","Cumetti","D.","Carrozzo","L.","Casarin","F.","Collini","V.","Imazio","M.","Brucato","A."],"significance":6,"published":"2026-03-18","source_date":"2026-03-18","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/spontane-coronaire-arterie-dissectie/","https://hartvaat.nl/kennis/diagnostiek/speckle-tracking-strain/"],"congress":"","summary_en":"The pericardium is considered electrically inert, yet diffuse ST-elevation is an ECG marker of acute pericarditis. The investigators hypothesised that ST-elevation reflects myocardial involvement. In this longitudinal multicentre study (351 pericarditis patients, 70 with myopericarditis defined by troponin elevation and/or MRI), 34.5% had ST-elevation; these patients were younger, more often male, with higher CRP and fewer pericardial effusions. Myocardial involvement occurred in 19.9% and more often with ST-elevation (26.4% vs 16.5%); ST-elevation predicted myocardial involvement (OR 1.82). Myopericarditis patients more often had transient systolic dysfunction, a lower remission rate (18.5% vs 31.2%) and slightly more hospitalisations, with comparable recurrence rates and treatment. ST-elevation in acute pericarditis thus indicates myocardial involvement — consistent with the pericardium being electrically inert.","created":"2026-07-03T10:32:22Z","updated":"2026-07-03T13:31:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Het pericard wordt als elektrisch inert beschouwd, terwijl diffuse ST-elevatie juist een ecg-kenmerk van acute pericarditis is. De onderzoekers veronderstelden dat ST-elevatie myocardiale betrokkenheid weerspiegelt. In deze longitudinale multicentrische studie (351 pericarditispatiënten, van wie 70 met myopericarditis op basis van troponinestijging en/of MRI) had 34,5% ST-elevatie; deze patiënten waren jonger, vaker man en hadden hogere CRP-waarden en minder vaak pericardvocht. Myocardiale betrokkenheid kwam bij 19,9% voor en vaker bij ST-elevatie (26,4% vs. 16,5%); ST-elevatie voorspelde myocardiale betrokkenheid (OR 1,82). Patiënten met myopericarditis hadden vaker voorbijgaande systolische disfunctie, een lagere remissiekans (18,5% vs. 31,2%) en iets meer ziekenhuisopnames, bij vergelijkbare recidiefkans en behandeling. ST-elevatie bij acute pericarditis wijst dus op myocardiale betrokkenheid — passend bij het idee dat het pericard elektrisch inert is.","abstract_original":"Background\n

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.

\n\nMethods\n

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.

\n\nResults\n

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).

\n

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.

\n\nConclusions\n

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.

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