Consensus documents have been developed by the American Society of Echocardiography, American College of Cardiology (ACC) and American Heart Association (AHA) as well as from the European Association of Cardiovascular Imaging on multimodality imaging of pericardial diseases [1, 2].

Both documents are consistent and provide an overview of the main diagnostic techniques with a special focus on echocardiography, computed tomography (CT) and cardiac magnetic resonance (CMR). Strengths and weaknesses are reviewed as well as the indications and specific findings in pericardial syndromes.

An additional position paper of the working group of myocardial and pericardial diseases addresses the triage of cardiac tamponade [3]. The position paper is essentially focused on the identification of patients who need immediate drainage of the pericardial effusion, the issue of guidance of pericardiocentesis either by echocardiography or fluoroscopy and selection criteria for the transfer to specialized/tertiary institution or surgical service.

The triage system is especially created on the basis of experts’ opinion and there is a need for a validation by additional prospective studies before it can be introduced and implemented in clinical practice.

National guidelines on the management of pericardial diseases have been also issued by the Spanish Society of Cardiology in 2000 [4] and more recently by the Brazilian Society of Cardiology in 2014 [5].

The first international guidelines on the management of pericardial diseases have been issued in 2004 by the European Society of Cardiology (ESC) [6]. However new important data have become available in the last 10 years, and new guidelines have been issued in 2015 by the ESC [7]. At present, there are no guidelines issued by the ACC/AHA.

First of all new diagnostic strategies have been proposed for the triage of patients with pericarditis and pericardial effusion and allow the selection of high-risk patients to be admitted as well as when and how additional diagnostic investigations are to be performed. Moreover specific clinical diagnostic criteria have been proposed for acute and recurrent pericarditis in clinical practice [8].

As mentioned, multimodality imaging for pericardial diseases has become an essential approach for a modern and comprehensive diagnostic evaluation, and this emerging diagnostic approach is now acknowledged, including the role of the detection of pericardial inflammation by imaging (CT/CMR) for the diagnosis of potentially reversible form of new-onset constrictive pericarditis [1, 2, 8].

The aetiology and pathophysiology of pericardial diseases remain to be better characterized, but new data supporting the immune-mediated pathogenesis of recurrences and new forms related to auto-inflammatory diseases have been documented, especially in paediatric patients.

The first prospective cohort studies have been performed on the prognosis and outcomes of acute pericarditis and myopericarditis. First epidemiological data have become available from retrospective studies on hospitalized patients.

Major advances have occurred in therapy with the first multicentre randomized clinical trials especially focused on the use of colchicine as adjunct to conventional anti-inflammatory therapies for the treatment and prevention of pericarditis.

Specific therapeutic dosing without a loading dose and weight-adjusted doses have been proposed to improve patient compliance.

Recurrences are the most troublesome complication of pericarditis, and new therapeutic choices have become available for refractory recurrent pericarditis, including alternative immunosuppressive therapies (e.g. azathioprine), iv immunoglobulins (IVIG) and interleukin-1 (IL-1) antagonists (e.g. anakinra). In these patients, also the role of pericardiectomy has been clarified as the last therapeutic option after failure of medical therapy.

In conclusion, significant new data has become available since 2004, and a new version of guidelines has become mandatory for clinical practice [7, 8].

The 2015 ESC guidelines [7] are divided into five main parts:

In the field of pericardial diseases, there are a limited number of randomized controlled trials. Therefore, the number of Class I Level A indications is limited. The 2015 ESC guidelines are essentially clinical practice guidelines to improve and guide the management of pericardial diseases [7, 8].

On this basis, they provide definitions and diagnostic criteria and practical management issues. The present book incorporates all the new recommendations.

The main new recommendations [7] can be grouped into the following categories: