Abstract
BackgroundEffusive 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.MethodsFrom 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.ResultsOf 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.ConclusionEffusive-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.
Highlights
Effusive-constrictive pericarditis (ECP) is a clinical syndrome in which compressive pericardial fluid and a constricting visceral pericardium occur simultaneously [1]
We have described the first prospective study of the prevalence and cytokine profile of hemodynamically proven effusive-constrictive disease in tuberculous pericardial effusion
Contrary to non-tuberculous forms of pericardial disease where effusive-constrictive disease is uncommon, Effusive constrictive pericarditis (ECP) occurs in half of cases of tuberculous pericardial effusion
Summary
Effusive-constrictive pericarditis (ECP) is a clinical syndrome in which compressive pericardial fluid and a constricting visceral pericardium occur simultaneously [1]. There are, no studies of tuberculous ECP that have used combined pericardiocentesis and cardiac catheterization, the ‘gold standard’ for the diagnosis of effusive-constrictive disease [8] It is unknown whether ECP has a biomarker profile that would shed light on the pathogenesis and diagnostic approach of this unique pericardial syndrome that is associated with inflammation and fibrosis. 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
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