Prognostic predictors in constrictive pericarditis, 19-year experience at a tertiary care hospital

Introduction Constrictive pericarditis is a chronic inflammatory entity that may progress with thickening and calcification in the pericardial tissue, resulting in decreased pericardial elasticity and subsequent increase in ventricular filling pressures1,2. This rare treatable cause of HFpEF, is associated with various aetiologies, depending on the development level of the countries. Several algorithms have been developed for the diagnosis, whereas studies evaluating the prognostic factors are limited3–6. Our study aimed to examine the clinical, laboratory, electrocardiographic, imaging and catheterization parameters that determine the prognosis of constrictive pericarditis. Methods 60 patients diagnosed with constrictive pericarditis based on echocardiography, computed tomography and right heart catheterization parameters were included retrospectively in the study. Clinical presentation, laboratory, and electrocardiographic findings were assessed. Volumetric measurement, tissue Doppler, mitral inflow velocity analysis, and pericardial evaluation were made via 2D echocardiography. Pericardial thickness, effusion, and calcium score were obtained via thorax CT, while right-sided pressure measurements were acquired via catheterization. The primary clinical outcome was determined as mortality, and the effect of these parameters was evaluated by Cox regression analysis. Results Median follow-up was 3.5 years (0-19) and mean age was 52.7 ±17.5 years. 38 of the patients (63.3%) were male, the most common aetiologies were malignancy (21.4%) and other systemic diseases (21.4%). 7 patients were lost to follow-up and 18 (31.6%) patients died during the process. When different models were evaluated with Cox regression analysis, ascites, hemoglobin and elevated proBNP values were prognostic predictors (HR 10.991 p-value 0.006, HR 0.513 p-value 0.010 and HR 3.904 p-value 0.045, respectively). ROC analysis indicated the highest AUC value for the model that included hemoglobin (AUC 0.953). Conclusion Constrictive pericarditis is one of the treatable causes of HFpEF. While imaging and catheterization parameters play a crucial role in the diagnosis, clinical and laboratory parameters affect the prognosis.