Calcific Constrictive Pericarditis: Is It Still with Us?

21 March 2000 | Volume 132 Issue 6 | Pages 444-450

Background: The presence of pericardial calcification on a plain radiograph strongly suggests constrictive pericarditis in patients with heart failure. However, calcific constrictive pericarditis is considered rare in the United States since tuberculosis incidence has decreased, and doubt has therefore been raised about the importance of this radiologic finding in modern cardiovascular practice.

Objective: To determine the clinical and prognostic significance of pericardial calcification on radiography in patients with constrictive pericarditis.

Design: Retrospective cohort study.

Setting: Tertiary referral center.

Patients: A consecutive series of 135 patients (mean age ± SD, 56 ± 16 years) who from 1985 through 1995 had constrictive pericarditis confirmed surgically (n = 133) or by autopsy (n = 2). Patients were divided into two groups: those with pericardial calcification on chest radiography (group I) and those without (group II).

Measurements: Clinical and diagnostic findings were compared in both groups, and outcome was compared in 132 patients who had pericardiectomy.

Results: Pericardial calcification was seen in 36 patients (27%). The cause of constrictive pericardial disease was indeterminate in 67% of patients in group I and in 21% of patients in group II (P < 0.001). Patients in group I had had symptoms for a longer period and were more likely to have pericardial knock, larger atrial size, and atrial arrhythmia. Significantly more perioperative deaths were seen in group I, but incidence of late survival and incidence of noncalcific disease were similar in both groups.

Conclusions: Pericardial calcification is a common finding in patients with constrictive pericarditis. It is often associated with idiopathic disease and other markers of disease chronicity and is an independent predictor of increased perioperative mortality rates.

Author and Article Information

From the Mayo Clinic and Mayo Foundation, Rochester, Minnesota.

Grant Support: Dr. Ling was supported by a Faculty Development Program Scholarship from the National University Hospital, Singapore, and by the Mayo Foundation.

Requests for Single Reprints: Jae K. Oh, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

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Current Author Addresses: Dr. Ling: Department of Medicine, National University of Singapore, Kent Ridge Crescent, Singapore 119074.

Drs. Oh, Breen, Schaff, Danielson, Seward, and Tajik and Mr. Mahoney: Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Author Contributions: Conception and design: L.H. Ling, J.K. Oh, A.J. Tajik.

Analysis and interpretation of the data: L.H. Ling, J.K. Oh, J.F. Breen, D.W. Mahoney.

Drafting of the article: L.H. Ling.

Critical revision of the article for important intellectual content: J.K. Oh, G.K. Danielson, H.V. Schaff, D.W. Mahoney, A.J. Tajik.

Final approval of the article: J.K. Oh, J.F. Breen, H.V. Schaff, G.K. Danielson, D.W. Mahoney, J.B. Seward, A.J. Tajik.

Provision of study materials or patients: G.K. Danielson, H.V. Schaff.