Prognostic Value of Initial Echocardiographic Features in Patients With Tuberculous Pericarditis

다국어 초록 (Multilingual 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.

참고문헌 (Reference)

1 Liu PY, "Usefulness of echocardiographic intrapericardial abnormalities in the diagnosis of tuberculous pericardial effusion" 87 : 1133-1135, 2001

2 Long R, "Tuberculous pericarditis:long-term outcome in patients who received medical therapy alone" 117 : 1133-1139, 1989

3 Williams IP, "Tuberculous pericarditis in south-west London:an increasing problem" 33 : 816-817, 1978

4 Komsuoglu B, "Tuberculous pericarditis in north-east Turkey:an echocardiographic study" 49 : 157-163, 1994

5 Mayosi BM, "Tuberculous pericarditis" 112 : 3608-3616, 2005

6 Hageman JH, "Tuberculosis of the pericardium:a long-term analysis of forty-four proved cases" 270 : 327-332, 1964

7 Haley JH, "Transient constrictive pericarditis:causes and natural history" 43 : 271-275, 2004

8 Park SY, "The usefulness of pericardial biopsy to evaluate the causes of pericardial disease" 29 : 517-522, 1999

9 Komsuoglu B, "The diagnostic and prognostic value of adenosine deaminase in tuberculous pericarditis" 16 : 1126-1130, 1995

10 Ng TT, "Serodiagnosis of pericardial tuberculosis" 88 : 317-320, 1995

11 Dal-Bianco JP, "Role of echocardiography in the diagnosis of constrictive pericarditis" 22 : 24-33, 2009

12 Jung HG, "Respiratory variations of Doppler echocardiographic parameters in cardiac tamponade" 28 : 412-424, 1998

13 Zumla A, "Reflections on the white plague" 9 : 197-202, 2009

14 Oh JK, "Preload reduction to unmask the characteristic Doppler features of constrictive pericarditis:a new observation" 95 : 796-799, 1997

15 Suwan PK, "Predictors of constrictive pericarditis after tuberculous pericarditis" 73 : 187-189, 1995

16 Mayosi BM, "Pericardial Disease: an Evidence- Based Approach to Diagnosis and Treatment. 2nd ed" BMJ Books 2003

17 Sinha PR, "Intrapericardial echogenic images and development of constrictive pericarditis in patients with pericardial effusion" 132 : 1268-1272, 1996

18 Kim SH, "Initial echocardiographic characteristics of pericardial effusion determine the pericardial complications" 136 : 151-155, 2009

19 George S, "Echocardiography in differentiating tuberculous from chronic idiopathic pericardial effusion" 90 : 1338-1339, 2004

20 Ku CS, "Echocardiographic features of tuberculous pericarditis" 66 : 613-616, 2003

21 Come PC, "Echocardiographic changes in rapidly developing pericardial constriction" 109 : 1385-1387, 1985

22 Chia BL, "Echocardiographic abnormalities in tuberculous pericardial effusion" 107 : 1034-1035, 1984

23 Oh JK, "Diagnostic role of Doppler echocardiography in constrictive pericarditis" 23 : 154-162, 1994

24 Yang CC, "Diagnosis of tuberculous pericarditis and treatment without corticosteroids at a tertiary teaching hospital in Taiwan:a 14-year experience" 38 : 47-52, 2005

25 Hinds SW, "Diagnosis of pericardial abnormalities by 2D-echo:a pathology-echocardiography correlation in 85 patients" 123 : 143-150, 1992

26 Yang HS, "Clinical characteristics of constrictive pericarditis diagnosed by echo-Doppler technique in Korea" 16 : 558-566, 2001

27 Mayosi BM, "Clinical characteristics and initial management of patients with tuberculous pericarditis in the HIV era:the Investigation of the Management of Pericarditis in Africa(IMPI Africa)registry" 6 : 2-, 2006

28 Syed FF, "A modern approach to tuberculous pericarditis" 50 : 218-236, 2007