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The Clinical Course of Tuberculous Pericarditis in Immunocompetent Hosts Based on Serial Echocardiography.

Authors
  • Kim, Min Sun1
  • Chang, Sung A2
  • Kim, Eun Kyoung1
  • Choi, Jin Oh1
  • Park, Sung Ji1
  • Lee, Sang Chol1
  • Park, Seung Woo1
  • Oh, Jae K1, 3
  • 1 Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. , (North Korea)
  • 2 Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. [email protected] , (North Korea)
  • 3 Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA.
Type
Published Article
Journal
Korean circulation journal
Publication Date
Jul 01, 2020
Volume
50
Issue
7
Pages
599–609
Identifiers
DOI: 10.4070/kcj.2019.0317
PMID: 32096358
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

In East Asia, tuberculous pericarditis still occurs in immunocompetent patients. We aimed to investigate clinical course of tuberculous pericarditis and the trends of echocardiographic parameters for constrictive pericarditis. We retrospectively analyzed medical records of patients with tuberculous pericarditis between January 2010 and January 2017 in Samsung Medical Center. Treatment consists of the standard 4-drug anti-tuberculosis regimen for 6 months with or without corticosteroids. We performed echocardiography at initial diagnosis, 1, 3 and 6 months later. Total 50 cases with tuberculous pericarditis in immunocompetent patients were enrolled. Echocardiographic finding at initial diagnosis divided into 3 groups: 1) pericardial effusion only (n=28, 56.0%), 2) effusive constrictive pericarditis (n=10, 20.0%) and 3) constrictive pericarditis (n=12, 24.0%). The proportion of patients with constrictive pericarditis decreased gradually over time. After 6 months, only 5 patients still had constrictive pericarditis. Out of the 28 patients who initially presented with effusion alone, only one patient developed constrictive pericarditis. Echocardiographic parameters representing constrictive pericarditis gradually disappeared over the follow up period. Ventricular interdependency improved significantly from 1 month follow-up, whereas septal bounce and pericardial thickening were still observed after 6 months without significant constrictive physiology. Tuberculous pericarditis with pericardial effusion without constrictive physiology is unlikely to develop into constrictive pericarditis in immunocompetent hosts, if treated with optimal anti-tuberculous medication and steroid therapy. Even though there were hemodynamic feature of constrictive pericarditis, more than 80% of the patients were improved from constrictive pericarditis. Copyright © 2020. The Korean Society of Cardiology.

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