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

Korean Circulation Journal 2020년 50권 7호 p.599 ~ 609
Kim Min-Sun, 장성아, 김은경, 최진오, 박성지, 이상철, 박성우, Oh Jae-K.,
소속 상세정보
 ( Kim Min-Sun ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
장성아 ( Chang Sung-A ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
김은경 ( Kim Eun-Kyoung ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
최진오 ( Choi Jin-Oh ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
박성지 ( Park Sung-Ji ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
이상철 ( Lee Sang-Chol ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
박성우 ( Park Seung-Woo ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
 ( Oh Jae-K. ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine

Abstract


Background and Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

키워드

Tuberculous pericarditis; Constrictive pericarditis; Echocardiography; Steroids

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