title: Calcific constrictive pericarditis: is it still with us?
abstract: BACKGROUND
  The presence of pericardial calcification on a plain radiograph strongly suggests constrictive pericarditis in patients with heart failure. However, calcific constrictive pericarditis is considered rare in the United States since tuberculosis incidence has decreased, and doubt has therefore been raised about the importance of this radiologic finding in modern cardiovascular practice.
  
  
  OBJECTIVE
  To determine the clinical and prognostic significance of pericardial calcification on radiography in patients with constrictive pericarditis.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  A consecutive series of 135 patients (mean age +/- SD, 56 +/- 16 years) who from 1985 through 1995 had constrictive pericarditis confirmed surgically (n = 133) or by autopsy (n = 2). Patients were divided into two groups: those with pericardial calcification on chest radiography (group I) and those without (group II).
  
  
  METHODS
  Clinical and diagnostic findings were compared in both groups, and outcome was compared in 132 patients who had pericardiectomy.
  
  
  RESULTS
  Pericardial calcification was seen in 36 patients (27%). The cause of constrictive pericardial disease was indeterminate in 67% of patients in group I and in 21% of patients in group II (P < 0.001). Patients in group I had had symptoms for a longer period and were more likely to have pericardial knock, larger atrial size, and atrial arrhythmia. Significantly more perioperative deaths were seen in group I, but incidence of late survival and incidence of noncalcific disease were similar in both groups.
  
  
  CONCLUSIONS
  Pericardial calcification is a common finding in patients with constrictive pericarditis. It is often associated with idiopathic disease and other markers of disease chronicity and is an independent predictor of increased perioperative mortality rates.
authors.affiliation: Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
authors.forename: L H
authors.initials: LH
authors.lastname: Ling
authors.forename: J K
authors.initials: JK
authors.lastname: Oh
authors.forename: J F
authors.initials: JF
authors.lastname: Breen
authors.forename: H V
authors.initials: HV
authors.lastname: Schaff
authors.forename: G K
authors.initials: GK
authors.lastname: Danielson
authors.forename: D W
authors.initials: DW
authors.lastname: Mahoney
authors.forename: J B
authors.initials: JB
authors.lastname: Seward
authors.forename: A J
authors.initials: AJ
authors.lastname: Tajik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000473:pathology*; D002648:Child; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D010492:Pericardiectomy; D010494:Pericarditis, Constrictive / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000473:pathology* / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies; D013223:Statistics as Topic; D016896:Treatment Outcome