Arthur K Mutyaba1, Sarvesh Balkaran1, Robert Cloete1, Naude du Plessis1, Motasim Badri2, Johan Brink3, Bongani M Mayosi1. 1. Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. 2. Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia. 3. Chris Barnard Division of Cardiothoracic Surgery, Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. Electronic address: Johan.Brink@uct.ac.za.
Abstract
OBJECTIVE: The causes of constrictive pericarditis and predictors of perioperative outcome after pericardiectomy have not been clearly elucidated, especially in Africa, where the disease characteristics differ from those in developed countries. Furthermore, the effect of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) on pericardial constriction and outcomes after surgery is unknown. We investigated the causes of constrictive pericarditis, outcomes after pericardiectomy, and predictors of mortality in Cape Town, South Africa, during a 22-year period of high HIV/AIDS prevalence. METHODS: A retrospective review of the medical records of all patients who had undergone pericardiectomy for constrictive pericarditis at Groote Schuur Hospital from January 1, 1990 to December 31, 2012 was performed. RESULTS: Of 121 patients, 36 (29.8%) had proven tuberculosis, 74 (61.2%) had presumed tuberculosis, 6 (5%) had idiopathic causes, and 5 (4%) had miscellaneous causes of constrictive pericarditis. Seventeen patients (14%) died perioperatively with low cardiac output syndrome the main cause of mortality. On multivariable analysis, serum sodium (hazard ratio, 0.88; 95% confidence interval, 0.80-0.97; P = .009) and preoperative New York Heart Association class IV (hazard ratio, 3.42; 95% confidence interval, 1.29-9.08; P = .014; vs combined class I-III) were independent predictors of early mortality. Of the 121 patients, 14 (11.6%) were HIV positive, with a mean CD4 cell count of 284 ± 133 cells/μL. No early deaths occurred in the HIV-positive patients. CONCLUSIONS: Tuberculosis is the main cause of constrictive pericarditis in South Africa. Despite its efficacy at relieving the symptoms of heart failure, pericardiectomy is associated with high perioperative mortality that was not influenced by HIV status. New York Heart Association functional class IV and hyponatremia predict for early mortality after pericardiectomy.
OBJECTIVE: The causes of constrictive pericarditis and predictors of perioperative outcome after pericardiectomy have not been clearly elucidated, especially in Africa, where the disease characteristics differ from those in developed countries. Furthermore, the effect of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) on pericardial constriction and outcomes after surgery is unknown. We investigated the causes of constrictive pericarditis, outcomes after pericardiectomy, and predictors of mortality in Cape Town, South Africa, during a 22-year period of high HIV/AIDS prevalence. METHODS: A retrospective review of the medical records of all patients who had undergone pericardiectomy for constrictive pericarditis at Groote Schuur Hospital from January 1, 1990 to December 31, 2012 was performed. RESULTS: Of 121 patients, 36 (29.8%) had proven tuberculosis, 74 (61.2%) had presumed tuberculosis, 6 (5%) had idiopathic causes, and 5 (4%) had miscellaneous causes of constrictive pericarditis. Seventeen patients (14%) died perioperatively with low cardiac output syndrome the main cause of mortality. On multivariable analysis, serum sodium (hazard ratio, 0.88; 95% confidence interval, 0.80-0.97; P = .009) and preoperative New York Heart Association class IV (hazard ratio, 3.42; 95% confidence interval, 1.29-9.08; P = .014; vs combined class I-III) were independent predictors of early mortality. Of the 121 patients, 14 (11.6%) were HIV positive, with a mean CD4 cell count of 284 ± 133 cells/μL. No early deaths occurred in the HIV-positive patients. CONCLUSIONS:Tuberculosis is the main cause of constrictive pericarditis in South Africa. Despite its efficacy at relieving the symptoms of heart failure, pericardiectomy is associated with high perioperative mortality that was not influenced by HIV status. New York Heart Association functional class IV and hyponatremia predict for early mortality after pericardiectomy.
Authors: Bongani M Mayosi; Mpiko Ntsekhe; Jackie Bosch; Shaheen Pandie; Hyejung Jung; Freedom Gumedze; Janice Pogue; Lehana Thabane; Marek Smieja; Veronica Francis; Laura Joldersma; Kandithalal M Thomas; Baby Thomas; Abolade A Awotedu; Nombulelo P Magula; Datshana P Naidoo; Albertino Damasceno; Alfred Chitsa Banda; Basil Brown; Pravin Manga; Bruce Kirenga; Charles Mondo; Phindile Mntla; Jacob M Tsitsi; Ferande Peters; Mohammed R Essop; James B W Russell; James Hakim; Jonathan Matenga; Ayub F Barasa; Mahmoud U Sani; Taiwo Olunuga; Okechukwu Ogah; Victor Ansa; Akinyemi Aje; Solomon Danbauchi; Dike Ojji; Salim Yusuf Journal: N Engl J Med Date: 2014-09-01 Impact factor: 91.245