BREAKING--Pericardial Effusions Skyrocketed During Pandemic

Salvucci et al. drop a bombshell: subclinical myopericarditis surged with vaccination rollout, peaking in 2022

By Peter A. McCullough, MD, MPH

As an echocardiographer, I have noticed an increase in significant pericardial effusions (fluid around the heart) since the pandemic started. This paper caught my attention.

---

📄 Summary: Salvucci et al. (2026) — Echocardiographic Pericardial Involvement

This retrospective cohort study analyzed 1,431 consecutive patients undergoing routine outpatient echocardiography at an Italian cardiology clinic from 2018 to 2022, comparing pre-pandemic and pandemic periods.

The headline finding is stark: pericardial involvement on echo jumped from 22.0% (101/459) pre-pandemic to 68.8% (463/673) during pandemic years — a more than threefold increase. Multivariable analysis revealed that SARS-CoV-2 vaccination was independently associated with roughly doubled odds of pericardial abnormalities (OR 2.08, 95% CI 1.29–3.35, P = 0.003), comparable to the risk from COVID-19 infection itself (OR 1.99, P = 0.012).

Critically, the temporal pattern is revealing: odds ratios relative to 2018 were 1.86 in 2020, then exploded to 6.95 in 2021 and 6.73 in 2022 — precisely when mass vaccination took full effect across the population. The dose-response analysis confirmed one and two doses each independently raised pericardial involvement risk (OR ~2.1), while the interaction analysis showed vaccination and infection operated through overlapping inflammatory pathways.

The study captured not just clinical pericarditis but minimal and residual pericardial alterations — small effusions, thickening, hyperechogenicity, fibrinous strands — exactly the kind of subclinical findings that passive surveillance systems miss. The authors themselves note that nearly 70% echo positivity during pandemic years suggests “many cases are asymptomatic or mildly symptomatic, escaping passive surveillance.”

This is precisely the phenomenon McCullough, Mead, and Hulscher (2025) characterized in their comprehensive review of COVID-19 vaccine-induced subclinical myopericarditis. They described a pathophysiological cascade in which mRNA vaccine-generated spike protein circulates systemically, triggers innate immune activation with CD68+ macrophage infiltration of myocardial and pericardial tissue, and produces low-grade inflammation that falls below the threshold of clinical detection yet is readily apparent on imaging. Their review documented that this subclinical cardiac injury — detectable by echocardiography, cardiac MRI, and elevated troponin — affects a far broader population than the rare cases of fulminant myocarditis captured by VAERS and other passive systems. The Salvucci data, showing nearly 7 in 10 vaccinated patients with echo-detectable pericardial involvement by 2021–2022, provides real-world clinical validation of McCullough’s thesis: what the medical establishment dismissed as “rare and mild” was in fact widespread and simply uninvestigated.

Please subscribe to FOCAL POINTS as a paying ($5 monthly) or founder member so we can continue to bring you the truth. AlterAI may be used to assist in searches, synthesis, and review.

Peter A. McCullough, MD, MPH

President, McCullough Foundation

FOCAL POINTS has partnered with AlterAI to defend your medical freedom. Subscribe to AlterAI today and get a discount on unbiased and accurate AI!

Sources:

Salvucci F, Petrella L, Foroni B, et al. (2026) Association of COVID-19 Infection and SARS-CoV-2 Vaccination With Echocardiographic Pericardial Involvement in a Real-World Outpatient Cohort. Cureus 18(7): e113147. doi:10.7759/cureus.113147

McCullough PA, Mead MN, Hulscher N. (2025) COVID-19 Vaccine-Induced Subclinical Myopericarditis: Pathophysiology, Diagnosis, and Clinical Management. Medical Research Archives, 13(11). doi:10.18103/mra.v13i11.7078