title: Prevalence, hemodynamics, and cytokine profile of effusive-constrictive pericarditis in patients with tuberculous pericardial effusion.
abstract: BACKGROUND
  Effusive constrictive pericarditis (ECP) is visceral constriction in conjunction with compressive pericardial effusion. The prevalence of proven tuberculous ECP is unknown. Whilst ECP is distinguished from effusive disease on hemodynamic grounds, it is unknown whether effusive-constrictive physiology has a distinct cytokine profile. We conducted a prospective study of prevalence and cytokine profile of effusive-constrictive disease in patients with tuberculous pericardial effusion.
  
  
  METHODS
  From July 2006 through July 2009, the prevalence of ECP and serum and pericardial levels of inflammatory cytokines were determined in adults with tuberculous pericardial effusion. The diagnosis of ECP was made by combined pericardiocentesis and cardiac catheterization.
  
  
  RESULTS
  Of 91 patients evaluated, 68 had tuberculous pericarditis. The 36/68 patients (52.9%; 95% confidence interval [CI]: 41.2-65.4) with ECP were younger (29 versus 37 years, P=0.02), had a higher pre-pericardiocentesis right atrial pressure (17.0 versus 10.0 mmHg, P<0.0001), serum concentration of interleukin-10 (IL-10) (38.5 versus 0.2 pg/ml, P<0.001) and transforming growth factor-beta (121.5 versus 29.1 pg/ml, P=0.02), pericardial concentration of IL-10 (84.7 versus 20.4 pg/ml, P=0.006) and interferon-gamma (2,568.0 versus 906.6 pg/ml, P=0.03) than effusive non-constrictive cases. In multivariable regression analysis, right atrial pressure > 15 mmHg (odds ratio [OR] = 48, 95%CI: 8.7-265; P<0.0001) and IL-10 > 200 pg/ml (OR=10, 95%CI: 1.1, 93; P=0.04) were independently associated with ECP.
  
  
  CONCLUSIONS
  Effusive-constrictive disease occurs in half of cases of tuberculous pericardial effusion, and is characterized by greater elevation in the pre-pericardiocentesis right atrial pressure and pericardial and serum IL-10 levels compared to patients with effusive non-constrictive tuberculous pericarditis.
authors.affiliation: Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, Western Cape, South Africa.
authors.forename: Mpiko
authors.initials: M
authors.lastname: Ntsekhe
authors.forename: Kerryn
authors.initials: K
authors.lastname: Matthews
authors.forename: Faisal F
authors.initials: FF
authors.lastname: Syed
authors.forename: Armin
authors.initials: A
authors.lastname: Deffur
authors.forename: Motasim
authors.initials: M
authors.lastname: Badri
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Commerford
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.forename: Katalin A
authors.initials: KA
authors.lastname: Wilkinson
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wilkinson
authors.forename: Bongani M
authors.initials: BM
authors.lastname: Mayosi
mesh_terms: D000328:Adult; D000349:Africa / Q000453:epidemiology; D016207:Cytokines / Q000097:blood*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010490:Pericardial Effusion / Q000097:blood / Q000150:complications* / Q000453:epidemiology* / Q000503:physiopathology; D010494:Pericarditis, Constrictive / Q000097:blood / Q000150:complications* / Q000453:epidemiology* / Q000503:physiopathology; D015995:Prevalence; D014376:Tuberculosis / Q000097:blood / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology
chemical_list: D016207:Cytokines