Calcific constrictive pericarditis: Is it still with us?

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 Uni ted States since tuberculosis incidence has decreased, and doubt has theref ore been raised about the importance of this radiologic finding in modern c ardiovascular practice. Objective: To determine the clinical and prognostic significance of pericar dial calcification on radiography in patients with constrictive pericarditi s. 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 s urgically (n = 133) or by autopsy (n = 2). Patients were divided into two g roups: 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 i n 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 pericar dial knock, larger atrial size, and atrial arrhythmia. Significantly more p erioperative deaths were seen in group I, but incidence of late survival an d 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.