title: Prognostic predictors in pericardiectomy for chronic constrictive pericarditis.
abstract: OBJECTIVE
  Prognosis after pericardiectomy remains to be clearly elucidated, especially in Asian countries, where the causes of constrictive pericarditis differ from those in Western countries. We aimed to investigate the preoperative prognostic factors and clinical outcomes after pericardiectomy in patients with chronic constrictive pericarditis.
  
  
  METHODS
  Preoperative clinical and imaging characteristics were evaluated in 85 consecutive patients with chronic constrictive pericarditis without other valvular or ischemic heart diseases who underwent pericardiectomy. Causes were idiopathic in 49 patients (57.6%) and tuberculous in 36 patients (42.4%). All-cause death was observed for a median of 38.5 months.
  
  
  RESULTS
  Of 85 patients, 15 (17.6%) died during follow-up. These 15 patients who died during follow-up had higher aspartate aminotransferase, smaller left ventricular end-systolic dimension index, and higher early diastolic mitral inflow velocity before pericardiectomy than the 70 patients who survived. Multivariate Cox proportional analysis showed that diabetes mellitus (hazard ratio, 4.610; P = .024) and high early diastolic mitral inflow velocity (hazard ratio, 1.050/cm/s; P = .002) before pericardiectomy were independent predictors of mortality after pericardiectomy. The preoperative cutoff value for early diastolic mitral inflow velocity in predicting mortality after pericardiectomy was 71 cm/s (sensitivity of 84.6% and specificity of 52.2%), and there was a significant difference in survival between groups divided by this cutoff value of early diastolic mitral inflow velocity (P = .029).
  
  
  CONCLUSIONS
  Preoperative high early diastolic mitral inflow velocity and diabetes mellitus were predictors of poor prognosis after pericardiectomy in patients with chronic constrictive pericarditis. These results suggest that preoperative Doppler echocardiographic evaluation may be valuable not only for diagnosing constrictive pericarditis but also for predicting prognosis after pericardiectomy.
authors: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Se Hun
authors: SH
authors: Kang
authors: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Electronic address: jmsong@amc.seoul.kr.
authors: Jong-Min
authors: JM
authors: Song
authors: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Minsoo
authors: M
authors: Kim
authors: Department of Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Suk Jung
authors: SJ
authors: Choo
authors: Department of Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Cheol Hyun
authors: CH
authors: Chung
authors: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Duk-Hyun
authors: DH
authors: Kang
authors: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Jae-Kwan
authors: JK
authors: Song
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015150:Echocardiography, Doppler; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010492:Pericardiectomy / Q000009:adverse effects / Q000401:mortality; D010494:Pericarditis, Constrictive / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: 32; AFB; CP; CT; CVP; IVC; LV; acid-fast bacilli; central venous pressure; computed tomography; constrictive pericarditis; inferior vena cava; left ventricular