Introduction:
Studies have described the changing landscape of patients with constrictive pericarditis (CP) in the modern era, however no systematic review or meta-analysis has been performed.
Methods:
We systematically searched the MEDLINE, Embase and Cochrane databases from their inception to April 1, 2020 for studies assessing the characteristics and outcomes patients with CP undergoing pericardiectomy. A meta-analysis was performed to assess the impact of CP etiology on outcomes.
Results:
We analyzed 27 eligible studies and 2114 patients. Etiology was most commonly idiopathic (50.2%), post-cardiac surgery (26.2%) and radiation (6.9%)(Figure 1A-B). Patients were mostly men (76%), with a mean age of 58 years and with advanced symptoms (NYHA III/IV 70.1%). Total pericardiectomy was preferred (85.8%) (Figure 1C-D) and concomitant cardiac surgery was relatively common (23.8%). Operative mortality was 6.9% and 5-year mortality was 32.7% (Table 1). Radiation and post-cardiac surgery patients had higher long-term risk for mortality respectively compared to idiopathic pericarditis (HR: 2.15; 95% CI: 1.21-1.36, p=.01 and HR: 3.21; 95% CI: 1.56-6.50, p<.01, respectively). Thirty percent of included studies had more than low bias. A sensitivity analysis did not result in changes in the results.
Conclusions:
Pericardiectomy is performed mostly in middle-aged men with advanced symptoms and low comorbidity burden and still carries a significant operative mortality. Radiation and post-cardiac surgery patients have a significantly higher risk compared to idiopathic. Several methodological issues and significant heterogeneity limit the generalization of these data.
Natriuretic peptides to differentiate constrictive pericarditis and restrictive cardiomyopathy: A systematic review and meta‐analysis
