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By Peter A. McCullough, MD, MPHAs 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 InvolvementThis retrospective cohort study analyzed1,431 consecutive patientsundergoing 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 from22.0%(101/459) pre-pandemic to68.8%(463/673) during pandemic years — a more than threefold increase. Multivariable analysis revealed thatSARS-CoV-2 vaccination was independently associated with roughly doubled oddsof 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 were1.86 in 2020, then exploded to6.95 in 2021and6.73 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 butminimal 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 phenomenonMcCullough, Mead, and Hulscher (2025)characterized in their comprehensive review ofCOVID-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.Thanks for reading FOCAL POINTS (Courageous Discourse™)! This post is public so feel free to share it.SharePlease subscribe to FOCAL POINTS as a paying ($5 monthly) or founder member so we can continue to bring you the truth.AlterAImay be used to assist in searches, synthesis, and review.Peter A. McCullough, MD, MPHPresident, McCullough FoundationFOCAL POINTS has partnered withAlterAIto defend your medical freedom. Subscribe toAlterAItoday 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.Cureus18(7): e113147. doi:10.7759/cureus.113147McCullough 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