Faculty Bibliography

Pericarditis is the most frequent manifestation of pericardial disease and accounts for up to 5% of emergency department visits for chest pain. Although traditionally considered a benign and self-limited condition, it is a heterogeneous syndrome with a broad aetiological spectrum and potentially significant morbidity. While mortality is low, the burden of complications like recurrent disease, cardiac tamponade or constrictive pericarditis, and the frequent need for hospitalisation underscore its clinical relevance. The growing availability of multimodality imaging and the publication of updated international guidelines in 2025 have recently renewed attention to pericardial diseases, refining diagnostic criteria, risk stratification and therapeutic approaches. In high-income settings, idiopathic or presumed viral pericarditis remains the most common presentation. However, a substantial proportion of patients harbour alternative aetiologies that carry distinct prognostic implications and require tailored diagnostic and management strategies. In this review, we use the ABCDE mnemonic as a pragmatic framework to highlight five clinically important and often under-recognised forms of pericardial disease. Pericarditis associated with autoimmune and systemic inflammatory diseases is typically characterised by recurrent or refractory inflammatory courses and frequent extracardiac involvement. Bacterial pericarditis, although rare, represents a life-threatening condition requiring rapid aetiological identification and aggressive therapy. Cancer-related pericardial disease often presents with large pericardial effusions or cardiac tamponade and is associated with a poor prognosis largely determined by the underlying malignancy. Damage-related and drug-related pericarditis encompasses postcardiac injury syndromes and pharmacological toxicity. Finally, endocrine and metabolic disorders, including uraemia, hypothyroidism and infiltrative conditions such as amyloidosis, are associated with pericardial disease that manifests with atypical features and effusion. Early recognition of these entities is critical, as management extends beyond standard anti-inflammatory therapy and often requires correction of the underlying cause and close multidisciplinary collaboration. This ABCDE approach can aid clinicians in identifying these uncommon high-risk forms of pericarditis and optimising patient-centred care.

IMPORTANCE/UNASSIGNED:Psoriasis is a chronic immune-mediated disease associated with cardiovascular, metabolic, musculoskeletal, psychiatric, hepatic, kidney, and pulmonary comorbidities. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are approved by the US Food and Drug Administration for type 2 diabetes, obesity, cardiovascular risk reduction, chronic kidney disease, obstructive sleep apnea, and metabolic dysfunction-associated steatohepatitis-conditions common in psoriasis. Emerging evidence suggests GLP-1 RAs and dual glucose-dependent insulinotropic polypeptide/GLP-1 agonists may improve psoriatic skin disease, partly through immune modulation. If confirmed in larger randomized clinical trials, GLP-1-based therapies may offer an opportunity to address both cutaneous disease and cardiometabolic comorbidities. This primer from the US National Psoriasis Foundation Medical Board sought to provide an evidence-informed narrative synthesis and practical considerations to introduce dermatologists to GLP-1 RAs for psoriasis treatment. OBSERVATIONS/UNASSIGNED:GLP-1 RAs have been associated with reductions in Psoriasis Area and Severity Index (PASI) scores, particularly in patients with obesity or type 2 diabetes. Studies report relative PASI reductions ranging from approximately 40% to 80% with parallel quality-of-life gains, although most of these studies are small (7-48 patients), short term (≤6 months), and lack a control group. Semaglutide and liraglutide have been associated with reductions in C-reactive protein, interleukin-6, lipids, and visceral adiposity. In small, translational cohorts, PASI improvement has been correlated with reductions in superficial adiposity and dermal γδ T-cell density. GLP-1 RAs combine safely with methotrexate, cyclosporine, and biologics. Adverse effects are mainly transient gastrointestinal symptoms; pancreatitis and gallbladder events are rare. Early data show both metabolic and immunomodulatory benefits. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This review found that GLP-1-based therapies target shared metabolic and inflammatory pathways in psoriasis. Current evidence supports consideration of adjunctive use in selected patients with metabolic comorbidities, although definitive conclusions await larger randomized clinical trials.

UNLABELLED:Systemic lupus erythematosus (SLE) is associated with increased cardiac morbidity and mortality and involves a range of cardiac pathologies. The most common of these is a simple pericardial effusion, though rarely this can be complicated by constrictive pericarditis. We present a case illustrating a rare SLE-mediated effusive-constrictive pericarditis. A 70-year-old female with a history of a prior stroke and coronary artery disease presented with 2 weeks of dyspnea, pleuritic chest pain, and fever. Her labs were notable for acute kidney injury with hematuria and proteinuria, elevated inflammatory markers, positive anti-nuclear antibody, low complement levels, and positive double-stranded DNA. CT scan of the chest showed circumferential pericardial effusion with echocardiogram and right heart catheterization confirming effusive-constrictive pericarditis. Clinically, she met diagnostic criteria for SLE and additionally underwent renal biopsy that confirmed SLE nephritis. The patient was started on colchicine, hydroxychloroquine, mycophenolate mofetil, and prednisone. A 3-month follow-up echocardiogram demonstrated resolution of the pericardial effusion and constrictive physiology. Effusive-constrictive pericarditis is a rare but important manifestation of pericardial disease in SLE. Treatment of the underlying SLE led to the resolution of the pericardial pathology. LEARNING OBJECTIVE/UNASSIGNED:Systemic lupus erythematosus (SLE) is a heterogeneous illness that causes significant morbidity and mortality across a variety of organ systems. Our aim is to educate clinicians on the spectrum of cardiac manifestations in SLE with a particular focus on pericardial disease. Using our case as a reference, we hope to highlight developments in diagnosis and management of pericardial disease in SLE.

BACKGROUND:Microvascular density and endothelial glycocalyx function may provide insights into early atherosclerosis and cardiovascular disease (CVD) risk. Sublingual sidestream darkfield (SDF) microscopy permits imaging of red blood cells (RBC) to assess the microcirculation. We sought to define reference ranges for SDF microscopy parameters in healthy populations and individuals with coronary artery disease (CAD) and to assess factors correlated with microcirculatory abnormalities. METHODS:Adults with and without CVD risk factors and epicardial CAD underwent SDF microscopy using a CapiScope Handheld Video Capillaroscopy System and Glycocheck analytic software to measure the perfused boundary region (a measure of RBC glycocalyx penetration), percent RBC filling (%RBC, a measure of microvascular perfusion) and microvascular density. RESULTS:<0.0001), though values overlapped substantially; after adjustment for demographics and CVD risk factors, obstructive CAD was not independently associated with sublingual microvascular parameters. CONCLUSIONS:Obstructive CAD was not associated with sublingual microvascular parameters after accounting for demographics and CVD risk factors. The overlap of microvascular parameters in patients with and without CAD limits the clinical utility of SDF microscopy to identify traditional CVD.

Despite major advances in medical therapies and prevention strategies, the risk of cardiovascular complications in patients with both type I and type II diabetes remains substantially elevated. In 2019, the American Heart Association sought applications for a Strategically Focused Research Network on Cardiometabolic Health and Type 2 Diabetes. In 2020, 4 centers were named, including Brigham and Women's Hospital, Johns Hopkins University, New York University, and the University of Iowa. These centers performed basic, translational, and clinical studies to provide insights to explain the over 2-fold risk of cardiovascular complications in diabetes. Clinical studies and studies in cells and animals aimed to uncover new mechanisms responsible for disease development. Studies using human populations sought to uncover new biomarkers to prognosticate risk. In this review, we discuss several key issues and current and developing methods to understand why diabetes drives atherosclerotic cardiovascular disease and heart failure. Both human data and experimental models are considered. We integrate a review of these topics with work from the Strategically Focused Research Network and conclude with suggestions for identifying novel risk factors and future experimental research.

BACKGROUND:Coronary artery calcium (CAC) scoring is strongly associated with cardiovascular (CV) events among the general population; however, its prognostic value among individuals with immune-mediated inflammatory diseases (IMIDs) is not well characterized. OBJECTIVES/OBJECTIVE:This study aims to assess the prevalence of CAC derived from routine chest computed tomography (CT) using a validated artificial intelligence (AI) algorithm and its association with adverse CV events among those with IMIDs. METHODS:The authors studied a retrospective cohort of all patients 40 to 70 years of age with a diagnosis of systemic lupus erythematosus, rheumatoid arthritis, or psoriatic disease, and no prior atherosclerotic cardiovascular disease who underwent chest CT at 2 medical centers in Boston, Massachusetts, USA, from 2000 to 2023 as part of routine care. The presence and severity of CAC was determined using a validated AI methodology. Cox proportional hazards modeling was used to assess the association of CAC-AI categories (CAC-AI = 0, CAC-AI = 1-99, and CAC-AI ≥100) with all-cause mortality and major adverse cardiovascular events (MACE) (nonfatal myocardial infarction, coronary revascularization, nonfatal stroke, or CV mortality). All models were adjusted for age, sex, and traditional CV risk factors. RESULTS:In total, 2,546 individuals with IMIDs (median age 59 years [Q1-Q3: 53-65 years]; 1,694 [66.5%] women) were included with a median follow-up of 8.1 years. Among this cohort, 53% had CAC-AI >0 while only 6.0% were on a statin. A low burden of CAC (CAC-AI = 1-99) was associated with an increased risk of all-cause mortality (adjusted HR: 1.41; P = 0.010) and MACE (adjusted HR: 2.05; P < 0.001) with even greater risk observed among individuals with CAC-AI ≥100 (adjusted HR: 2.45; P < 0.001) and MACE (adjusted HR: 3.24; P < 0.001). CONCLUSIONS:Among those with IMIDs, incidental CAC-AI was highly prevalent and significantly associated with both all-cause mortality and MACE. These findings suggest that CAC-AI may provide important prognostic information, allowing for improved risk stratification and treatment within an already high-risk and undertreated population.