Risk of Constrictive Pericarditis After Acute Pericarditis

• Published in: Circulation (New York, N.Y.) Vol. 124; no. 11; pp. 1270 - 1275
• Main Authors: IMAZIO, Massimo, BRUCATO, Antonio, MAESTRONI, Silvia, CUMETTI, Davide, BELLI, Riccardo, TRINCHERO, Rita, ADLER, Yehuda
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 13-09-2011
• Subjects: Acute Disease; Adult; Aged; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cohort Studies; Coronary heart disease; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Middle Aged; Pericarditis - complications; Pericarditis - diagnosis; Pericarditis - epidemiology; Pericarditis, Constrictive - diagnosis; Pericarditis, Constrictive - epidemiology; Pericarditis, Constrictive - etiology; Prospective Studies; Risk Factors; Pericardial constriction; Prognosis; constrictive pericarditis; pericarditis; Heart disease; Risk factor; Pericardial disease; Cardiovascular disease
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circulationaha.111.018580

Constrictive pericarditis (CP) is considered a rare, dreaded possible complication of acute pericarditis. Nevertheless, there is a lack of prospective studies that have evaluated the specific risk according to different etiologies. The aim of this study is to evaluate the risk of CP after acute pericarditis in a prospective cohort study with long-term follow-up.
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 CP. 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 3 cases (0.6%). During a median follow-up of 72 months (range, 24 to 120 months), CP 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 CP was 0.76 cases per 1000 person-years for idiopathic/viral pericarditis, 4.40 cases per 1000 person-years for connective tissue disease/pericardial injury syndrome, 6.33 cases per 1000 person-years for neoplastic pericarditis, 31.65 cases for 1000 person-years for tuberculous pericarditis, and 52.74 cases per 1000 person-years for purulent pericarditis.
CP is a relatively rare complication of viral or idiopathic acute pericarditis (<0.5%) but, in contrast, is relatively frequent for specific etiologies, especially bacterial.