Porta-Sánchez Andreu, Sagristà-Sauleda Jaume, Ferreira-González Ignacio, Torrents-Fernández Asunción, Roca-Luque Ivo, García-Dorado David
Servicio de Cardiología, Hospital Universitari Vall d'Hebron i Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Rev Esp Cardiol (Engl Ed). 2015 Dec;68(12):1092-100. doi: 10.1016/j.rec.2014.12.018. Epub 2015 Apr 27.
Some reports have described a change in the etiologic spectrum of constrictive pericarditis. In addition, data on the relationship between its clinical presentation and etiology are lacking. We sought to describe the etiologies of the disease, their relationship with its clinical presentation and surgical findings, and to identify predictors of poor outcome.
We analyzed 140 consecutive patients who underwent surgery for constrictive pericarditis over a 34-year period in a single center.
The etiology was idiopathic in 76 patients (54%), acute idiopathic pericarditis in 24 patients (17%), tuberculous pericarditis in 15 patients (11%), purulent pericarditis in 10 patients (7%), and cardiac surgery, radiation and uremia in 5, 3 and 2 patients respectively (4%, 2% and 1%). Mean duration of symptoms before pericardiectomy was 19 months (standard deviation, 44 months), the most acute presentation being for purulent pericarditis (26 days [range, 7-60 days]) and the most chronic for idiopathic cases (29 months [range, 4 days-360 months]). Perioperative mortality was 11%. There was no difference in mortality between etiologies. Median follow-up was 12 years (range, 0.1-33.0 years) in which 50 patients died. In a Cox-regression analysis, age at surgery, advanced New York Heart Association functional class (III to IV) and previous acute idiopathic pericarditis were associated with increased mortality during follow-up.
Most cases of constrictive pericarditis are idiopathic. Cardiac surgery and radiation accounted for a minority of cases. Etiologic investigations are warranted only in acute or subacute presentations. Age, advanced functional class, and previous acute idiopathic pericarditis are associated with increased mortality.
一些报告描述了缩窄性心包炎病因谱的变化。此外，关于其临床表现与病因之间关系的数据尚缺。我们试图描述该病的病因、它们与临床表现及手术发现的关系，并确定预后不良的预测因素。
我们分析了在一个中心34年间连续接受缩窄性心包炎手术的140例患者。
76例患者（54%）病因不明，24例患者（17%）为急性特发性心包炎，15例患者（11%）为结核性心包炎，10例患者（7%）为化脓性心包炎，分别有5例、3例和2例患者（4%、2%和1%）病因是心脏手术、放疗和尿毒症。心包切除术前行症状的平均持续时间为19个月（标准差44个月），最急性的表现为化脓性心包炎（26天[范围7 - 60天]），最慢性的为特发性病例（29个月[范围4天 - 360个月]）。围手术期死亡率为11%。各病因之间死亡率无差异。中位随访时间为12年（范围0.1 - 33.0年），其中50例患者死亡。在Cox回归分析中，手术时年龄、纽约心脏协会心功能分级晚期（III至IV级）和既往急性特发性心包炎与随访期间死亡率增加相关。
大多数缩窄性心包炎病例病因不明。心脏手术和放疗占少数病例。仅在急性或亚急性表现时才有必要进行病因调查。年龄、心功能分级晚期和既往急性特发性心包炎与死亡率增加相关。
