Prognostic value of initial echocardiographic features in patients with tuberculous pericarditis

Abstract

Background and objectives: Tuberculous (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 methods: We evaluated initial presentation and clinical outcomes (mean follow-up 32±27 months) in 60 consecutive patients newly diagnosed with TB pericarditis.

Results: Initial 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.

Conclusion: Initial 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.

Keywords: Echocardiography; Pericarditis; Prognosis; Tuberculosis.

Fig. 1

Representative examples of echo-free pericardial effusion (PE) (A) and echogenic PE (B). PE: pericardial effusion.

Fig. 2

Clinical outcomes of tuberculous pericarditis patients according to clinical and echocardiographic classifications.

Fig. 3

Kaplan-Meier analyses of developing persistent constrictive pericarditis in patients with or without initial pericardial constriction (A), and in patients with echogenic pericardial effusion (PE) or echo-free PE (B). PE: pericardial effusion.

Fig. 4

Kaplan-Meier analyses of pericardiectomy in patients with or without initial pericardial constriction (A), and in patients with echogenic pericardial effusion (PE) or echo-free PE (B). PE: pericardial effusion.

Fig. 5

Kaplan-Meier analyses of persistent constrictive pericarditis in patients with or without steroid therapy in patients with initial echogenic pericardial effusion or constrictive physiology (n=38).