What is the clinical evidence from this study?

Study design: Cohort. Population: Constrictive pericarditis (n=135). Intervention: Pericardial calcification on chest radiography vs. No pericardial calcification. Primary outcome: Indeterminate cause of constrictive pericardial disease (p=<0.001).

March 21, 2000

Calcific Constrictive Pericarditis: Is It Still with Us?

Q: What are the key findings of this study?

Pericardial calcification was associated with a higher rate of indeterminate disease cause (67% vs 21%, P<0.001) and independently predicted increased perioperative mortality.

Key Result

Pericardial calcification was associated with a higher rate of indeterminate disease cause (67% vs 21%, P<0.001) and independently predicted increased perioperative mortality.

Study Design

Type

Cohort (n=135)

Multicenter

Structured PICO

Does the presence of pericardial calcification on radiography affect clinical characteristics and outcomes in patients with constrictive pericarditis?

Population

135 patients (mean age 56 +/- 16 years) with constrictive pericarditis confirmed surgically (n=133) or by autopsy (n=2) from 1985 through 1995 at a tertiary referral center.

Intervention

Presence of pericardial calcification on chest radiography

Comparator

Absence of pericardial calcification on chest radiography

Outcome

Clinical and diagnostic findings, perioperative mortality, and late survival after pericardiectomyhard clinical

Pericardial calcification remains a common finding in constrictive pericarditis, often associated with idiopathic disease and chronicity, and independently predicts higher perioperative mortality.

Main Result

Absolute Event Rate: 67% vs 21%

p-value: p=<0.001

Abstract

BACKGROUND: The presence of pericardial calcification on a plain radiograph strongly suggests constrictive pericarditis in patients with heart failure. However, calcific constrictive pericarditis is considered rare in the United States since tuberculosis incidence has decreased, and doubt has therefore been raised about the importance of this radiologic finding in modern cardiovascular practice. OBJECTIVE: To determine the clinical and prognostic significance of pericardial calcification on radiography in patients with constrictive pericarditis. DESIGN: Retrospective cohort study. SETTING: Tertiary referral center. PATIENTS: A consecutive series of 135 patients (mean age +/- SD, 56 +/- 16 years) who from 1985 through 1995 had constrictive pericarditis confirmed surgically (n = 133) or by autopsy (n = 2). Patients were divided into two groups: those with pericardial calcification on chest radiography (group I) and those without (group II). MEASUREMENTS: Clinical and diagnostic findings were compared in both groups, and outcome was compared in 132 patients who had pericardiectomy. RESULTS: Pericardial calcification was seen in 36 patients (27%). The cause of constrictive pericardial disease was indeterminate in 67% of patients in group I and in 21% of patients in group II (P < 0.001). Patients in group I had had symptoms for a longer period and were more likely to have pericardial knock, larger atrial size, and atrial arrhythmia. Significantly more perioperative deaths were seen in group I, but incidence of late survival and incidence of noncalcific disease were similar in both groups. CONCLUSIONS: Pericardial calcification is a common finding in patients with constrictive pericarditis. It is often associated with idiopathic disease and other markers of disease chronicity and is an independent predictor of increased perioperative mortality rates.

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