Bharadwaj Rajeev, Kynta Reuben L, Rawat Sanjib, Lyngdoh Bifica
Department of Cardiology, All India Institute of Medical Sciences, Guwahati, Guwahati, IND.
Department of Cardiothoracic and Vascular Surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND.
Cureus. 2024 Nov 3;16(11):e72953. doi: 10.7759/cureus.72953. eCollection 2024 Nov.
Introduction Chronic constrictive pericarditis (CCP) is a progressive disease characterized by thickening and fibrosis of the pericardium, leading to restricted diastolic filling and impaired cardiac function. In Northeast India, limited healthcare infrastructure poses challenges in diagnosing and managing CCP, potentially worsening patient outcomes. Therefore, this study aims to assess the demographic and clinical profiles of patients with CCP in this region over 10 years and compare our findings to the relevant but limited published literature in South Asia. Methods We retrospectively analyzed the medical records of 42 patients diagnosed with CCP referred to our department from 2011 to 2020. Demographic, clinical, and paraclinical data during hospitalization and follow-up were collected. All patients underwent clinical examination imaging studies, including high-resolution chest computed tomography and echocardiography. Symptomatic patients underwent open pericardiectomy, and postoperative histopathological examination was performed. Results Of the 42 patients, 34 (81%) were male and eight (19%) were female. A significant proportion of the patients were under the age of 20 years (n = 18, 42.9%), followed by the 21- to 40-year age group (n = 13, 31%). Eighteen patients (42.9%) were from Meghalaya, 12 (28.6%) were from Assam, and seven (16.7%) were from Nagaland. Twenty-two patients (52.4%) had a prior history of pulmonary or extrapulmonary tuberculosis (TB) and had received antitubercular therapy for at least six months. Dyspnea on exertion was the most common symptom among the patients: 12 (28.6%) of them were classified as New York Heart Association class IV, 20 (47.6%) as class III, and 10 (23.8%) as class II. Clinical examination revealed pedal edema in 36 (85.7%), hepatomegaly in 22 (52.4%), ascites in 15 (35.7%), and pleural effusion in 13 (31%) patients. Echocardiography showed septal bounce in 26 (61.9%), pericardial calcification in 17 (40.5%), and hepatic vein flow reversal in 12 (28.6%) patients. All patients were on diuretics and digoxin before surgery. Postoperative biopsy confirmed TB as the etiology in 28 (66.7%) patients and nonspecific etiology in 14 (33.3%) of them. Conclusions CCP in Northeast India predominantly affects young males and is largely associated with TB. Despite efforts to control TB, it remains a major contributor to CCP in this region. Recognizing the clinical presentation and diagnostic profile is essential for improving management strategies and patient outcomes.
引言
慢性缩窄性心包炎（CCP）是一种进行性疾病，其特征为心包增厚和纤维化，导致舒张期充盈受限和心功能受损。在印度东北部，有限的医疗基础设施给CCP的诊断和管理带来挑战，可能使患者预后恶化。因此，本研究旨在评估该地区10年来CCP患者的人口统计学和临床特征，并将我们的研究结果与南亚相关但有限的已发表文献进行比较。
方法
我们回顾性分析了2011年至2020年转诊至我科的42例诊断为CCP的患者的病历。收集了住院期间和随访期间的人口统计学、临床和辅助检查数据。所有患者均接受了临床检查及影像学检查，包括高分辨率胸部计算机断层扫描和超声心动图。有症状的患者接受了心包切除术，并进行了术后组织病理学检查。
结果
42例患者中，34例（81%）为男性，8例（19%）为女性。相当一部分患者年龄在20岁以下（n = 18，42.9%），其次是21至40岁年龄组（n = 13，31%）。18例（42.9%）患者来自梅加拉亚邦，12例（28.6%）来自阿萨姆邦，7例（16.7%）来自那加兰邦。22例（52.4%）患者有肺或肺外结核（TB）病史，并接受了至少6个月的抗结核治疗。劳力性呼吸困难是患者中最常见的症状：其中12例（28.6%）被归类为纽约心脏协会IV级，20例（47.6%）为III级，10例（23.8%）为II级。临床检查发现36例（85.7%）患者有足背水肿，22例（52.4%）有肝肿大，15例（35.7%）有腹水，13例（31%）有胸腔积液。超声心动图显示26例（61.9%）患者有室间隔跳动，17例（40.5%）有心包钙化，12例（28.6%）有肝静脉血流逆转。所有患者术前均使用利尿剂和地高辛。术后活检证实28例（66.7%）患者的病因是TB，14例（33.3%）患者的病因是非特异性的。
结论
印度东北部的CCP主要影响年轻男性，且在很大程度上与TB相关。尽管努力控制TB，但它仍然是该地区CCP的主要促成因素。认识临床表现和诊断特征对于改善管理策略和患者预后至关重要。
