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Risk of Constrictive Pericarditis After Acute Pericarditis
Study Questions:
What is the risk of constrictive pericarditis after acute pericarditis in a prospective cohort study with long-term follow-up?
Methods:
From January 2000 to December 2008, 500 consecutive cases with a first episode of acute pericarditis (age 51 ± 16 years; 270 men) were prospectively studied to evaluate the evolution toward constrictive pericarditis. Etiologies were viral/idiopathic in 416 cases (83.2%), connective tissue disease/pericardial injury syndromes in 36 cases (7.2%), neoplastic pericarditis in 25 cases (5.0%), tuberculosis in 20 cases (4.0%), and purulent in three cases (0.6%).
Results:
During a median follow-up of 72 months (range 24-120 months), constrictive pericarditis developed in 9 of 500 patients (1.8%): 2 of 416 patients with idiopathic/viral pericarditis (0.48%) versus 7 of 84 patients with a nonviral/nonidiopathic etiology (8.3%). The incidence rate of constrictive pericarditis was 0.76 cases per 1,000 person-years for idiopathic/viral pericarditis, 4.40 cases per 1,000 person-years for connective tissue disease/pericardial injury syndrome, 6.33 cases per 1,000 person-years for neoplastic pericarditis, 31.65 cases for 1,000 person-years for tuberculous pericarditis, and 52.74 cases per 1,000 person-years for purulent pericarditis.
Conclusions:
The authors concluded that constrictive pericarditis is a relatively rare complication of viral or idiopathic acute pericarditis (<0.5%) but, in contrast, is relatively frequent for specific etiologies, especially bacterial.
Perspective:
Constrictive pericarditis is a rare complication of acute pericarditis, known to occur at a significant rate after tuberculous pericarditis. However, most episodes of acute pericarditis are nontuberculous, with the predominance of cases due to viral or idiopathic etiologies. This large series of patients with acute pericarditis and median follow-up of 6 years demonstrates that constrictive pericarditis occurs rarely after idiopathic/viral acute pericarditis, with progressively increasing rates of occurrence associated after acute pericarditis due to connective tissue disease/pericardial injury syndrome, neoplastic pericarditis, tuberculous pericarditis, and purulent pericarditis.
Keywords: Connective Tissue Diseases, Incidence, Follow-Up Studies, Pericarditis, Constrictive, Tuberculosis, Syndrome, Pericarditis
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