Calcific Constrictive Pericarditis

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The summary below is from the full report titled "Calcific Constrictive Pericarditis: Is It Still with Us?" It is in the 21 March 2000 issue of Annals of Internal Medicine (volume 132, pages 444-450). The authors are L.H. Ling, J.K. Oh, J.F. Breen, H.V. Schaff, G.K. Danielson, D.W. Mahoney, J.B. Seward, and A.J. Tajik.

What is the problem and what is known about it so far?

Calcium deposits in the sac around the heart (pericardium) can sometimes be seen on x-rays. When these calcium deposits occur in patients with heart failure, they suggest a condition known as constrictive pericarditis. In this condition, stiff scar tissue in the pericardium squeezes the heart and prevents it from beating normally. Tuberculosis used to be a common cause of constrictive pericarditis; now, as tuberculosis has become less frequent in the United States, more common causes are previous heart operation, pericarditis, and radiation treatment.

Why did the researchers do this particular study?

They wanted to learn the significance of calcium deposits in the pericardium in patients with constrictive pericarditis during recent years, a time when tuberculosis has been relatively uncommon.

Who was studied?

One hundred thirty-five patients seen at the Mayo Clinic between 1985 and 1995 who definitely had constrictive pericarditis.

How was the study done?

The researchers examined patients' chest x-rays to see how many had visible calcium deposits. They then compared how well patients did according to whether calcium was or was not seen in the pericardium.

What did the researchers find?

Calcium deposits were seen in the pericardium in 36 of the 135 patients. The patients with calcium deposits more often had an unknown cause of constrictive pericarditis than those without the deposits. Patients with calcium deposits were also more likely to have been sick a long time, to have other signs of pericarditis on physical examination, and to die during surgery performed to remove the diseased pericardium. However, in patients who survived surgery, those with calcium deposits lived as long as those without them over the long term.

What were the limitations of the study?

All of the patients were studied at a single institution; it is unclear whether the results would be the same for patients in other geographic areas. Also, it is possible that newer and more accurate ways of examining the pericardium, such as CT scan, may predict more accurately which patients with constrictive pericarditis will do poorly.

What are the implications of the study?

Although tuberculosis is now uncommon, calcium deposits in the pericardium are still often found on x-rays of patients with constrictive pericarditis. The presence of these deposits may indicate that patients have had the condition longer and may possibly be a sign that they are more likely to die during surgery to remove the diseased pericardium.