Constrictive Pericarditis: Etiologic Spectrum, Patterns of Clinical Presentation, Prognostic Factors, and Long-term Follow-up.
OBJECTIVE
Some reports have described a change in the etiologic spectrum of constrictive pericarditis. In addition, data on the relationship between its clinical presentation and etiology are lacking. We sought to describe the etiologies of the disease, their relationship with its clinical presentation and surgical findings, and to identify predictors of poor outcome.


METHODS
We analyzed 140 consecutive patients who underwent surgery for constrictive pericarditis over a 34-year period in a single center.


RESULTS
The etiology was idiopathic in 76 patients (54%), acute idiopathic pericarditis in 24 patients (17%), tuberculous pericarditis in 15 patients (11%), purulent pericarditis in 10 patients (7%), and cardiac surgery, radiation and uremia in 5, 3 and 2 patients respectively (4%, 2% and 1%). Mean duration of symptoms before pericardiectomy was 19 months (standard deviation, 44 months), the most acute presentation being for purulent pericarditis (26 days [range, 7-60 days]) and the most chronic for idiopathic cases (29 months [range, 4 days-360 months]). Perioperative mortality was 11%. There was no difference in mortality between etiologies. Median follow-up was 12 years (range, 0.1-33.0 years) in which 50 patients died. In a Cox-regression analysis, age at surgery, advanced New York Heart Association functional class (III to IV) and previous acute idiopathic pericarditis were associated with increased mortality during follow-up.


CONCLUSIONS
Most cases of constrictive pericarditis are idiopathic. Cardiac surgery and radiation accounted for a minority of cases. Etiologic investigations are warranted only in acute or subacute presentations. Age, advanced functional class, and previous acute idiopathic pericarditis are associated with increased mortality.
Servicio de Cardiología, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: anporta@vhebron.net.
Andreu
A
Porta-Sánchez
Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Jaume
J
Sagristà-Sauleda
Unidad de Epidemiología, Servicio de Cardiología, Hospital Universitari Vall d'Hebron, CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
Ignacio
I
Ferreira-González
Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Asunción
A
Torrents-Fernández
Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Ivo
I
Roca-Luque
Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
David
D
García-Dorado
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010492:Pericardiectomy / Q000401:mortality; D010494:Pericarditis, Constrictive / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
Acute idiopathic pericarditis; Constricción pericárdica; Constrictive pericarditis; Pericardial constriction; Pericardiectomy; Pericardiectomía; Pericarditis; Pericarditis aguda idiopática; Pericarditis constrictiva