Prognostic Value of Initial Echocardiographic Features in Patients With Tuberculous Pericarditis

Abstract

Background and ObjectivesTuberculous (TB) pericarditis is a major cause of constrictive pericarditis requiring pericardiectomy. We sought to determine initial prognostic factors in patients with TB pericarditis.Subjects and MethodsWe evaluated initial presentation and clinical outcomes (mean follow-up 32±27 months) in 60 consecutive patients newly diagnosed with TB pericarditis.ResultsInitial presentations were pericardial effusion (PE), effusive-constrictive pericarditis, and constrictive pericarditis in 45 (75%), 9 (15%), and 6 (10%) patients, respectively. Of the 54 patients without initial constrictive pericarditis, 32 (59%) showed echogenic materials in PE, including frond-like exudative coating and fibrinous strands. These patients had a longer disease duration before diagnosis, were initially more symptomatic, in a more advanced state, showed more persistent pericardial constrictions (38% vs. 0%, p<0.001) despite anti-TB medications, and tended to require pericardiectomy more often (19% vs. 0%, p=0.07, p<0.05 by Kaplan-Meier). All patients with effusive-constrictive pericarditis showed echogenic PE. Of the 60 total patients, 10 (17%) underwent pericardiectomies during follow-up. All of these patients showed initial pericardial constrictions, whereas no patient without initial pericardial constriction underwent pericardiectomy (p<0.001). Seven patients showed transient pericardial constrictions that resolved without pericardiectomy.ConclusionInitial pericardial constriction and echogenic PE are poor prognostic signs for persistent pericardial constriction and pericardiectomy in patients with newly diagnosed TB pericarditis. These results suggest that early diagnosis and prompt anti-TB medication may be critical.

Clinical Case: Tuberculous Myopericarditis in the Cardiology Practice

“…Сложность, с которой может столкнуться клиницист любой специальности, заключается в том, что перикардит является проявлением общего распространенного инфекционного или неинфекционного процесса. Клиническая симптоматика весьма разнообразна и зависит от течения перикардита (острое или хроническое), количества и характера жидкости в перикарде, наличия осложнений и, главным образом, от характера течения основного процесса (в описанном нами случае -туберкулезного) перикардита [1][2][3][4].…”

Predictive factors for unfavorable outcomes of tuberculous pericarditis in human immunodeficiency virus–uninfected patients in an intermediate tuberculosis burden country

“…Dyspnea on exertion is a key symptom of acute pericardial tamponade that requires emergency pericardiocentesis and has a high risk for mortality [24]. Choi et al reported that patients who were initially more symptomatic, and had echogenic pericardial effusions tended to require pericardiectomy more often, and had more advanced disease [25]. From these results, it can be presumed that patients with large amounts of pericardial effusion are likely to experience dyspnea leading to hemodynamic compromise, which is correlated with unfavorable outcomes.…”

Tuberculous pericarditis presenting as massive haemorrhagic pericardial effusion

“…However, the small sample size renders the results inconclusive. Choi et al 21 tried to identify predictors of subsequent constrictive pericarditis and the need for pericardiectomy and found that the presence of pericardial constriction and echogenic pericardial effusion on initial presentation may be poor prognostic factors. In cases of reaccumlation of pericardial effusion, pericardial window should be considered to relieve and prevent cardiac tamponade 22.…”