The optimal duration of anti-tuberculous therapy before pericardiectomy in constrictive tuberculous pericarditis

Fang, Lingling; Yu, Guocan; Ye, Bo; Zhong, Fangming; Chen, Gang

doi:10.1186/s13019-021-01691-9

Cited by 5 publications

(3 citation statements)

References 28 publications

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“… 22 The majority of cases with poor prognoses are due to delayed diagnosis, and effectively diagnosing TBP is the clinical focus. 23 , 24 The diagnosis of patients without pericardial effusion is more difficult than that of patients with adequate pericardial effusion and usually necessitates invasive procedures to obtain specimens. 19 The microbiological diagnosis remains the most critical aspect of TBP diagnosis, with the AFB smear and MTB culture still being the most classical microbiological tests for TB diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Clinical Application of the Mycobacterium tuberculosis-RNA Assay of Pericardial Tissue Specimens in the Diagnosis of Tuberculous Pericarditis

Zhang¹,

Bu²,

Yao³

et al. 2023

IDR

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Purpose To assess the accuracy of the Mycobacterium tuberculosis (MTB)-RNA assay using pericardial tissue specimens for tuberculous pericarditis (TBP) diagnosis. Methods MTB culture and MTB-RNA assay were performed for patients with suspected TBP. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of these two assays were analyzed. Results This study included 79 patients. The sensitivity, specificity, PPV, NPV, and AUC were 28.1% (18/64), 100.0% (15/15), 100.0% (18/18), 24.6% (15/61), and 0.64 for the MTB culture and 37.5% (24/64), 100.0% (15/15), 100.0% (24/24), 27.3% (15/55), and 0.69 for the MTB-RNA assay, respectively. Patients with positive pericardial tissue culture were defined as having definite TBP; in other words, culture was the gold standard for this group of patients and had a sensitivity, specificity, PPV, and NPV of 100% and an AUC of 1.00. However, these values were found to be 72.2% (13/18), 100.0% (15/15), 100.0% (13/13), 75.0% (15/20), and 0.86 for the MTB-RNA assay, respectively. Among patients with probable TBP (culture-negative patients), the sensitivity, specificity, NPV, and AUC of MTB culture were 0.0% (0/46), 100.0% (15/15), 24.6% (15/61), and 0.50, respectively, but the PPV could not be determined. These values were found to be 23.9% (11/46), 100.0% (15/15), 100.0% (11/11), 30.0% (15/50), and 0.62 for the MTB-RNA assay, respectively. Conclusion MTB-RNA assay using pericardial tissues had limited diagnostic efficacy for TBP. In culture-positive TBP, the diagnostic accuracy of MTB-RNA was good. In contrast, in culture-negative TBP, its diagnostic accuracy was unsatisfactory.

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Section: Discussionmentioning

confidence: 99%

Clinical Application of the Mycobacterium tuberculosis-RNA Assay of Pericardial Tissue Specimens in the Diagnosis of Tuberculous Pericarditis

Zhang¹,

Bu²,

Yao³

et al. 2023

IDR

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“…The pericardium over the right atrium and vena cava was removed last. [22][23][24] Radical pericardiectomy provided superior 10-year survival and clinical functional improvement in patients with chronic constrictive pericarditis compared to sub-total pericardiectomy. 25…”

Section: Pericardiectomy Without Cardiopulmonary Bypass (Incomplete P...mentioning

confidence: 99%

Pericardiectomy for Constrictive Pericarditis with or without Cardiopulmonary Bypass

Huang,

Tang

2024

VHRM

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Aim We aim to access the effect of pericardiectomy for constrictive pericarditis with or without cardiopulmonary bypass. Methods This was a review of pericardiectomy for constrictive pericarditis. Results Cardiopulmonary bypass is actually an important maneuver to attain complete relief of the constriction. The short additional time of cardiopulmonary bypass during the procedure has very little effect on the risk of morbidity of the main operation. Conclusion Incomplete pericardiectomy perhaps was the cause of postoperative remnant constriction and high diastolic filling pressure leading to multiorgan failure. Complete pericardiectomy (removal of phrenic-to-phrenic and the postero-lateral and inferior wall pericardial thickening) using cardiopulmonary bypass should be the routine for total relief of the constriction of the heart.

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“… 11 Previous studies suggested that combination therapy strategy should be administered for 1 to 2 months before pericardiectomy, but whether different preoperative anti-TB regimens may lead to different outcomes is unclear. 12 , 13 This study aims to explore the effect of different anti-TB regimens on pericardial TB activity and prognosis in patients with TCP.…”

Section: Introductionmentioning

confidence: 99%

Clinical Significance of Preoperative Pyrazinamide-Containing Therapy in Tuberculous Constrictive Pericarditis

Fang,

Yu,

et al. 2024

IDR

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Background Tuberculous constrictive pericarditis (TCP) is recommended to be treated with anti-tuberculosis (TB) therapy before pericardiectomy. Whether different preoperative anti-TB regimens may lead to different outcomes is unclear. Methods We retrospectively collected patients diagnosed as TCP and received pericardiectomy from April 2016 to June 2023. The study patients were assigned into the active TCP (A-TCP) group and the inactive TCP (IA-TCP) group according to the results of Mycobacterium tuberculosis (MTB) culture and MTB RNA assay. Baseline characteristics including anti-TB regimens and surgical outcomes were compared between the two groups. Logistic regression analysis and subgroup analysis were conducted to identify the protective factors of A-TCP. Results Of the 102 study patients, 24 was in the A-TCP group and 78 was in the IA-TCP group. The rate of preoperative anti-TB regimen containing pyrazinamide was 37.5% in the A-TCP group, as compared with 74.4% in the IA-TCP group (P = 0.001). Multivariate analysis showed that preoperative use of pyrazinamide was the protective factor of A-TCP (OR 0.194, 95% CI 0.053–0.703, P = 0.013). Subgroup analysis based on age also showed consistent findings. In the analyses of surgical outcomes, A-TCP was the independent risk factor of postoperative cardiac complications (OR 4.231, 95% CI 1.317–13.593, P = 0.015) and associated with longer hospital stay (P = 0.004) and higher hospitalization cost (P = 0.001). Conclusion A strategy involving anti-TB regimen containing pyrazinamide before pericardiectomy was superior to that without pyrazinamide in the patients with TCP. The strategy was associated with lower risk of A-TCP and might lead to better postoperative recovery and cost-effectiveness.

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The optimal duration of anti-tuberculous therapy before pericardiectomy in constrictive tuberculous pericarditis

Cited by 5 publications

References 28 publications

Clinical Application of the Mycobacterium tuberculosis-RNA Assay of Pericardial Tissue Specimens in the Diagnosis of Tuberculous Pericarditis

Clinical Application of the Mycobacterium tuberculosis-RNA Assay of Pericardial Tissue Specimens in the Diagnosis of Tuberculous Pericarditis

Pericardiectomy for Constrictive Pericarditis with or without Cardiopulmonary Bypass

Clinical Significance of Preoperative Pyrazinamide-Containing Therapy in Tuberculous Constrictive Pericarditis

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