Chronic Constrictive Pericarditis in Northeast India: A 10-Year Single-Center Study of Demographic and Clinical Profiles

Abstract

Introduction Chronic constrictive pericarditis (CCP) is a progressive disease characterized by thickening and fibrosis of the pericardium, leading to restricted diastolic filling and impaired cardiac function. In Northeast India, limited healthcare infrastructure poses challenges in diagnosing and managing CCP, potentially worsening patient outcomes. Therefore, this study aims to assess the demographic and clinical profiles of patients with CCP in this region over 10 years and compare our findings to the relevant but limited published literature in South Asia. Methods We retrospectively analyzed the medical records of 42 patients diagnosed with CCP referred to our department from 2011 to 2020. Demographic, clinical, and paraclinical data during hospitalization and follow-up were collected. All patients underwent clinical examination imaging studies, including high-resolution chest computed tomography and echocardiography. Symptomatic patients underwent open pericardiectomy, and postoperative histopathological examination was performed. Results Of the 42 patients, 34 (81%) were male and eight (19%) were female. A significant proportion of the patients were under the age of 20 years (n = 18, 42.9%), followed by the 21- to 40-year age group (n = 13, 31%). Eighteen patients (42.9%) were from Meghalaya, 12 (28.6%) were from Assam, and seven (16.7%) were from Nagaland. Twenty-two patients (52.4%) had a prior history of pulmonary or extrapulmonary tuberculosis (TB) and had received antitubercular therapy for at least six months. Dyspnea on exertion was the most common symptom among the patients: 12 (28.6%) of them were classified as New York Heart Association class IV, 20 (47.6%) as class III, and 10 (23.8%) as class II. Clinical examination revealed pedal edema in 36 (85.7%), hepatomegaly in 22 (52.4%), ascites in 15 (35.7%), and pleural effusion in 13 (31%) patients. Echocardiography showed septal bounce in 26 (61.9%), pericardial calcification in 17 (40.5%), and hepatic vein flow reversal in 12 (28.6%) patients. All patients were on diuretics and digoxin before surgery. Postoperative biopsy confirmed TB as the etiology in 28 (66.7%) patients and nonspecific etiology in 14 (33.3%) of them. Conclusions CCP in Northeast India predominantly affects young males and is largely associated with TB. Despite efforts to control TB, it remains a major contributor to CCP in this region. Recognizing the clinical presentation and diagnostic profile is essential for improving management strategies and patient outcomes.

Keywords: chronic constrictive pericarditis; demographic pattern; extra-pulmonary tuberculosis (eptb); north-east india; rapid review.

Figure 1. Hematoxylin and Eosin (H&E) stained sections of tuberculous pericarditis showing epithelioid granulomas (blue arrow), caseous necrosis (yellow arrow), and Langhans giant cells (black arrow)

Figure 2. Modified Ziehl-Neelsen stain showing acid-fast bacilli (green arrow) on high-power microscopy