Background: Pre-operative prognostic factors and clinical outcomes after pericardiectomy remain to be clearly elucidated, especially in oriental countries where the etiologies of constrictive pericarditis (CP) are different from those in western countries.
Methods: Pre-operative clinical and imaging characteristics were evaluated in 111 consecutive patients with chronic CP who underwent pericardiectomy. Etiologies were idiopathic in 48 patients (43%), tuberculous in 39 (35%), and prior cardiac surgery in 14 patients (13%). Clinical events defined as cardiac death and hospital admission for heart failure were observed for a median of 33.5 months.
Results: Of 111 patients, 14 (13%) died and 14 (13%) admitted to hospital for heart failure during follow-up period. The 28 patients with clinical events were older (57.5짹15 vs. 49.9짹13.4 years, p=0.013), more symptomatic (NYHA class III & IV, 54% vs. 28%, p=0.013), had a longer duration of symptom (7.5짹9.2 vs. 4.2짹3.9 months, p=0.011) and had more coronary artery disease (18% vs. 1%, p=0.001), and showed smaller left ventricular (LV) diastolic (39.7짹5.7 vs. 42.9짹7.5 mm, p=0.047) and systolic dimensions (26짹4.9 vs. 29.9짹7.2 mm, p=0.01) before pericardiectomy than 83 patients without events. By multivariate Cox proportional hazard model, age [hazard ratio (HR): 1.037, 95% confidence interval (CI): 1.006 - 1.068, p=0.018], presence of coronary disease (HR: 6.290, 95% CI: 2.286 - 17.309, p<0.001), NYHA class III & IV (HR: 3.093, 95% CI: 1.399 - 6.837, p=0.005), and a small LV diastolic dimension (HR: 0.914 per 1 mm, 95% CI: 0.854 - 0.977, p=0.008) before pericardiectomy were independent predictors for clinical events after pericardiectomy. LV diastolic dimension of 41 mm was the best cutoff value by ROC curve analysis.
Conclusion: Pre-operative symptom severity and small LV diastolic dimension were poor prognostic factors after pericardiectomy, independent of age and coronary artery disease in patients with chronic CP.