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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 5, September/October 2019
AFRICA
251
Cardiovascular Topics
The effects of HIV/AIDS on the clinical profile and
outcomes post pericardiectomy of patients with
constrictive pericarditis: a retrospective review
DP Naidoo, G Laurence, B Sartorius, S Ponnusamy
Abstract
Objective:
The clinical profile and surgical outcomes of
patients with constrictive pericarditis were compared in
HIV-positive and -negative individuals.
Methods:
This study was a retrospective analysis of patients
diagnosed with constrictive pericarditis at Inkosi Albert
Luthuli Central Hospital, Durban, over a 10-year period
(2004–2014).
Results:
Of 83 patients with constrictive pericarditis, 32
(38.1%) were HIV positive. Except for pericardial calcifica-
tion, which was more common in HIV-negative subjects (
n
=
15, 29.4% vs
n
=
2, 6.3%;
p
=
0.011), the clinical profile
was similar in the two groups. Fourteen patients died pre-
operatively (16.9%) and three died peri-operatively (5.8%).
On multivariable analysis, age (OR 1.17; 95% CI: 1.03–1.34;
p
=
0.02), serum albumin level (OR 0.63; 95% CI: 0.43–0.92;
p
=
0.016), gamma glutamyl transferase level (OR 0.97; 95%
CI: 0.94–0.1.0;
p
=
0.034) and pulmonary artery pressure (OR
1.49; 95% CI: 1.07–2.08;
p
=
0.018) emerged as independent
predictors of pre-operative mortality rate. Peri-operative
complications occurred more frequently in HIV-positive
patients [9 (45%) vs 6 (17.6%);
p
=
0.030].
Conclusions:
Without surgery, tuberculous constrictive peri-
carditis was associated with a high mortality rate. Although
peri-operative complications occurred more frequently,
surgery was not associated with increased mortality rates in
HIV-positive subjects.
Keywords:
constrictive pericarditis, HIV, pericardiectomy
Submitted 16/5/18, accepted 5/3/19
Published online 30/8/19
Cardiovasc J Afr
2019;
30
: 251–257
www.cvja.co.zaDOI: 10.5830/CVJA-2019-015
Constrictive pericarditis remains an uncommon yet treatable
cause of heart failure.
1,2
The hallmark of constrictive pericarditis
is impaired ventricular diastolic filling caused by a thickened,
fibrosed pericardium, resulting in decreased stroke volume and
varying degrees of systemic venous congestion.
2-5
The natural
history of this disorder remains unknown.
6
While medical therapy has been used to successfully
treat patients with constriction in its early stages, surgical
pericardiectomy remains the only treatment for chronic
constrictive pericarditis.
7,8
The surgical mortality rate remains
high and has been reported to be between five and 14% in
multiple large series.
1,2,6,9-15
Over the past two decades, there has been a changing spectrum
of constrictive pericarditis in the developedworld, with a declining
incidence of infective aetiologies, in particular tuberculosis.
1,3
In sub-Saharan Africa, tuberculosis remains the dominant
cause; about 30 to 60% of patients diagnosed with tuberculous
pericarditis progress to constriction despite appropriate anti-
tuberculous therapy and adjunctive corticosteroids.
16
The effect of HIV on the incidence, natural history and
surgical outcomes of patients with constrictive pericarditis has
not been adequately documented.
2
Recent data suggest that
co-existing HIV infection may modify the clinical manifestations
and natural history of tuberculous pericarditis and resultant
constriction.
17,18
Our study was designed to evaluate the clinical
profile and surgical outcomes of HIV-positive and -negative
patients with constrictive pericarditis.
Methods
This study was a retrospective chart review of all patients
referred to Inkosi Albert Luthuli Central Hospital in Durban,
KwaZulu-Natal, for evaluation and management of suspected
constrictive pericarditis during the period 2004–2014. Patients
eligible for inclusion in the study constituted those in whom
the diagnosis of constrictive pericarditis was confirmed using
a combination of clinical symptoms and signs associated with
typical echocardiographic and computer tomography (CT) scan
findings.
Clinical supporting features included peripheral oedema,
ascites, pleural effusions, hepatomegaly, elevated jugular venous
pressure and pericardial knock. Typical echocardiographic
features of constriction were a thickened echogenic pericardium
accompanied by paradoxical interventricular septal motion, and
dilated non-compressible hepatic veins and inferior vena cava.
Department of Cardiology, University of KwaZulu-Natal,
Durban, South Africa
DP Naidoo, MD, FRCP,
naidood@ukzn.ac.zaG Laurence, FCP (SA), MMed (UKZN)
S Ponnusamy, MB ChB, FCP (SA), Cert Cardiol (Physicians (SA))
Department of Public Health, University of KwaZulu-Natal,
Durban, South Africa
B Sartorius, PhD