Abstract 9237: Spectrum of Constrictive Pericarditis: 10-Year Experience

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Introduction: Contemporary data on clinical presentation and outcomes of constrictive pericarditis (CP) in a community setting is lacking. We investigated the clinical spectrum of CP in a real-world setting. Hypothesis: Diagnosis of CP in contemporary clinical practice is difficult and frequently requires multimodality testing, with possible impact on clinical outcomes. Methods: A retrospective cohort of patients with surgically proven CP from January 2000 to December 2009 was studied. Baseline characteristics, clinical presentation, radiological imaging, cardiac catheterization and echocardiographic examinations were reviewed. Results: A total of 43 patients (median age 67; 76.7% male) were identified during the 10-year period. The majority presented with dyspnea (91%) and peripheral edema (72%), while anasarca and ascites were present in 33% of patients. Calcification on chest X-ray was present in 17% (5 of 29 cases), while catheterization hemodynamics suggested CP in 81% (25 of 31 cases). Computed tomography and/or magnetic resonance imaging showed pericardial thickening in 67% (20 of 30 studies). A specific etiology was found in 67% of the cohort (figure). Combined pericardiectomy with other cardiac surgery was undertaken in 35%. The perioperative 30-day mortality rate was 16%. At a median follow-up of 9 months, survival rate excluding perioperative mortality was 72%. Depressed ejection fraction (<40%) was a predictor of perioperative mortality (odds ratio: 8.27, 95% confidence interval [CI]: 1.41-48.54; p=0.019), while prior cardiac surgery was associated with reduced long-term survival (odds ratio: 6.82, 95% CI: 1.47-31.61; p=0.014). Conclusions: Our findings reaffirm the complexity of diagnosing constrictive pericarditis in contemporary medical practice. Early suspicion in clinical groups at risk for constrictive pericarditis and prompt surgical intervention prior to systolic dysfunction may improve outcomes.

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