Background: Among patients with pericardial effusion (PE), tuberculous PE (TPE) often presents with similar clinical features to idiopathic PE (IPE). However, comparisons in clinical features and prognostic factors between the two disease categories remain to be investigated.
Methods: From January 1997 to December 2009, consecutive 59 patients diagnosed as TPE and 57 patients as IPE were enrolled. Initial clinical, laboratory and echocardiographic characteristics were evaluated. Clinical outcomes, defined as repeated drainage of PE, pericardiectomy and death, were observed for a median of 30 months.
Results: Patients with TPE were more likely to present with symptoms such as fever, night sweat, and weight loss than those with IPE. Loculated PE and significant constrictive physiology on the initial echocardiography were more prevalent in TPE than in IPE. Multivariate Cox proportional hazard model for all 116 patients revealed that TPE (hazard ratio: 6.0, 95% confidence interval: 1.78-20.41, p=0.004) and the initial significant constrictive physiology (hazard ratio: 3.37, 95% confidence interval: 1.54-7.35, p=0.002) were independent predictors for clinical events. The patients with initial constriction showed lower event-free survival rates than those without, both among patients with TPE (p=0.034) and IPE (p<0.001)(Figure). Among 99 patients without initial constriction, event-free survival rate in patients with TPE was lower than that in patients with IPE (p<0.001), whereas it was not significantly different between the two etiologies among 17 patients with initial constriction (p=0.962).
Conclusions: TPE is associated with more symptoms at the initial presentation than IPE. A significant constrictive physiology on the initial echocardiography should be regarded as a major prognostic factor in both patients with TPE and IPE. Etiology seems to implicate a prognostic value in patients without constrictive physiology at the initial diagnosis.