title: Prognostic value of initial echocardiographic features in patients with tuberculous pericarditis.
abstract: OBJECTIVE
  Tuberculous (TB) pericarditis is a major cause of constrictive pericarditis requiring pericardiectomy. We sought to determine initial prognostic factors in patients with TB pericarditis.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Hyung Oh
authors.initials: HO
authors.lastname: Choi
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Song
authors.forename: Tae Sun
authors.initials: TS
authors.lastname: Shim
authors.forename: Sang-Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: In-Hyun
authors.initials: IH
authors.lastname: Jung
authors.forename: Duk-Hyun
authors.initials: DH
authors.lastname: Kang
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Song