Prevalence, Hemodynamics, and Cytokine Profile of Effusive-Constrictive Pericarditis in Patients with Tuberculous Pericardial Effusion

Ntsekhe, Mpiko; Matthews, Kerryn; Syed, Faisal F.; Deffur, Armin; Badri, Motasim; Commerford, Patrick; Gersh, Bernard J.; Wilkinson, Katalin A.; Wilkinson, Robert J.; Mayosi, Bongani M.

doi:10.1371/journal.pone.0077532

Cited by 33 publications

(21 citation statements)

References 24 publications

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“…In our study, the prevalence of ECP in patients with tuberculous pericardial effusions was 50%. This closely resembles the 52.9% reported in the study by Ntsekhe et al,5) where hemodynamic and biochemical characteristics of tuberculous ECP were described in 36 patients. Patients with ECP were generally younger, and their pre-pericardiocentesis RAPs were higher than those without ECP 5).…”

Section: Discussionsupporting

confidence: 91%

“…The prevalence of a tuberculous etiology of ECP was higher (67%) in our cohort of patients than in any of the previously published studies. In the series published by Ntsekhe et al,5) the prevalence of tuberculosis was 60%, while only one case of tuberculosis was identified by Sagristà-Sauleda et al4) (no data are provided on the prevalence in the larger cohort of patients who underwent pericardiocentesis), and none was identified in the articles by Cameron et al3) or Hancock 2). This clearly reflects the high prevalence of tuberculosis in the geographical area where the current study was conducted 14).…”

Section: Discussionmentioning

confidence: 68%

“…It was first formally described by Hancock2) in 1971, and only four series have been reported since 2)3)4)5). The condition is generally believed to be rare, occurring in only 1.2% of patients with a pericardial effusion, but it is more frequently found in the context of tuberculous pericardial disease (52.9%) 6).…”

Section: Introductionmentioning

confidence: 99%

“…The condition is generally believed to be rare, occurring in only 1.2% of patients with a pericardial effusion, but it is more frequently found in the context of tuberculous pericardial disease (52.9%) 6). The diagnosis of ECP is made by employing direct, invasive, hydrostatic pressure recordings in the pericardial space and the right atrium both pre- and post-pericardiocentesis 1)2)4)5). The invasive, and hence more hazardous, time-consuming and expensive nature of direct pressure measurements makes this method of diagnosis unattractive.…”

Section: Introductionmentioning

confidence: 99%

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Redefining Effusive-Constrictive Pericarditis with Echocardiography

Bijl

Herbst

Doubell

2016

J Cardiovasc Ultrasound

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BackgroundEffusive-constrictive pericarditis (ECP) is traditionally diagnosed by using the expensive and invasive technique of direct pressure measurements in the pericardial space and the right atrium. The aim of this study was to assess the diagnostic role of echocardiography in tuberculous ECP.MethodsIntrapericardial and right atrial pressures were measured pre- and post-pericardiocentesis, and right ventricular and left ventricular pressures were measured post-pericardiocentesis in patients with tuberculous pericardial effusions. Echocardiography was performed post-pericardiocentesis. Traditional, pressure-based diagnostic criteria were compared with post-pericardiocentesis systolic discordance and echocardiographic evidence of constriction.ResultsThirty-two patients with tuberculous pericardial disease were included. Sixteen had ventricular discordance (invasively measured), 16 had ECP as measured by intrapericardial and right atrial invasive pressure measurements and 17 had ECP determined echocardiographically. The sensitivity and specificity of pressure-guided measurements (compared with discordance) for the diagnosis of ECP were both 56%. The positive and negative predictive values were both 56%. The sensitivity of echocardiography (compared with discordance) for the diagnosis of ECP was 81% and the specificity 75%, while the positive and the negative predictive values were 76% and 80%, respectively.ConclusionEchocardiography shows a better diagnostic performance than invasive, pressure-based measurements for the diagnosis of ECP when both these techniques are compared with the gold standard of invasively measured systolic discordance.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Redefining Effusive-Constrictive Pericarditis with Echocardiography

Bijl

Herbst

Doubell

2016

J Cardiovasc Ultrasound

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“…ECP is believed to be a manifestation of pericardial TB4 as it progresses to a fibrous constrictive pericarditis 4 5. Previous literature has described the incidence of ECP in the setting of tuberculous pericarditis to range from 3% to 14% 6. Our patient presented with a significant abdominal trauma concomitant with an underlying tuberculous pericarditis.…”

Section: Discussionmentioning

confidence: 74%

Effusive-constrictive tuberculous pericarditis in the setting of penetrating abdominal trauma

et al. 2015

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Tuberculous pericarditis is rare in developed nations and is most commonly associated with effusive-constrictive pericarditis. We present the case of a 33-year-old man with a self-inflicted mid-abdominal stab wound. The patient underwent an exploratory laparotomy, revealing a grade IV pancreatic transection and injuries to the portal vein, right renal vein, inferior vena cava and the superior mesenteric vein. Repair of the vessels was performed and a pancreaticojejunostomy with a gastrojejunostomy was created for the pancreatic injury. The patient's hospital course was complicated by tuberculous effusive-constrictive pericarditis requiring emergent median sternotomy with opening of the pericardial sac and eventual expiration. The final cultures from the pericardial fluid demonstrated tuberculosis.

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