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Clinical characteristics of constrictive pericarditis diagnosed by echo-Doppler technique in Korea
1Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Tuberculosis remains a primary cause of constrictive pericarditis (CP) in Korea, sometimes leading to transient CP. Early diagnosis and treatment decisions are vital for improving patient survival rates.
Area of Science:
- Cardiology
- Infectious Diseases
- Thoracic Surgery
Background:
- Constrictive pericarditis (CP) is a serious cardiac condition affecting prognosis.
- Etiologies of CP vary globally, impacting treatment strategies and outcomes.
- Understanding the specific causes and characteristics of CP in different regions is crucial.
Purpose of the Study:
- To analyze the clinical data of patients diagnosed with constrictive pericarditis.
- To identify the etiological factors, treatment outcomes, and prognostic indicators in CP patients.
- To evaluate the impact of different management strategies on patient survival.
Main Methods:
- Retrospective analysis of clinical data from 71 constrictive pericarditis patients.
- Diagnosis confirmed using the echo-Doppler technique.
- Evaluation of treatment outcomes, including medical management and surgical pericardiectomy.
Main Results:
- Tuberculosis (32%), cardiac surgery (11%), and mediastinal irradiation (9%) were the most frequent causes of CP.
- Pericardiectomy was performed in 49% of patients with a 6% surgical mortality.
- 15% of patients achieved complete resolution with medical treatment; transient CP patients had better survival.
- Factors associated with higher mortality included mediastinal irradiation, older age, and lower functional class.
Conclusions:
- Tuberculosis is a significant cause of constrictive pericarditis in Korea, potentially leading to transient forms.
- Early diagnosis and timely intervention, guided by echocardiography, are essential for improving CP patient prognosis.
- Surgical pericardiectomy offers improved survival compared to non-surgical management in selected CP patients.
Abstract:
A retrospective analysis of clinical data of 71 patients with constrictive pericarditis (CP) diagnosed by echo-Doppler technique (mean age, 49+/-17) was done. In 27 patients (38%), the etiology was unknown, and the three most frequent identifiable causes were tuberculosis (23/71, 32%), cardiac surgery (8/71, 11%), and mediastinal irradiation (6/71, 9%). Pericardiectomy was performed in 35 patients (49%) with a surgical mortality of 6% (2/35), and 11 patients (15%, 11/ 71) showed complete resolution of constrictive physiology with medical treatment. Patients with transient CP were characterized by absence of pericardial calcification, shorter symptom duration, and higher incidence of fever, weight loss, and tuberculosis. The 5-yr survival rates of patients with transient CP and those undergoing pericardiectomy were 100% and 85+/-6%, respectively, which were significantly higher than that of patients without undergoing pericardiectomy (33+/-17%, p=0.0083). Mediastinal irradiation, higher functional class, low voltage in ECG, low serum albumin, and old age were the independent variables associated with a higher mortality. Tuberculosis is still the most important etiology of CP in Korea, and not infrequently, it may cause transient CP. Early diagnosis and decision-making using follow-up echocardiography are crucial to improve the prognosis of patients with CP.