Pericardial Diseases in Clinical Practice: Current Diagnostic Strategies, Therapeutic Advances, and Future Directions

Abstract

Pericardial diseases comprise a diverse spectrum of disorders, including acute and recurrent pericarditis, pericardial effusion, cardiac tamponade, constrictive pericarditis, and neoplastic pericardial involvement, all of which contribute substantially to cardiovascular morbidity. This narrative review synthesizes recent evidence on the epidemiology, pathophysiological mechanisms, contemporary diagnostic strategies, therapeutic advances, and future developments in pericardiology. Current evidence demonstrates that multimodality imaging, particularly echocardiography, cardiac computed tomography, and cardiovascular magnetic resonance, has significantly improved diagnostic precision, disease characterization, and risk stratification. Advances in understanding inflammatory pathways have facilitated the introduction of targeted therapies, including interleukin-1 inhibition, which has enhanced disease control in patients with recurrent and treatment-resistant pericarditis. Emerging innovations such as inflammatory biomarkers, artificial intelligence-assisted imaging, wearable monitoring devices, and digital health technologies are further supporting precision-based diagnosis, individualized treatment planning, and long-term surveillance. Despite these advances, recurrent disease, delayed diagnosis, heterogeneous clinical presentation, and variability in treatment response remain important challenges that continue to affect patient outcomes. Future progress will depend on integrating multidisciplinary care, standardized evidence-based clinical pathways, precision medicine, and robust clinical research to translate technological innovations into routine practice. Collectively, these developments are expected to improve diagnostic accuracy, optimize therapeutic decision-making, reduce disease recurrence, and enhance long-term outcomes for patients with pericardial diseases.