Pericardial calcification in tuberculous constrictive pericarditis: a marker of chronicity unassociated with early postoperative outcomes.

Background: Tuberculous constrictive pericarditis (TCP) can progress to a chronic, calcific stage, restricting cardiac function. The role of pericardial calcification, best assessed by cardiac computed tomography (CT), in predicting surgical outcomes is unclear. We aimed to evaluate the association of pericardial calcification with clinical features, cardiac structural/functional alterations, and early postoperative outcomes in TCP patients undergoing pericardiectomy. Methods: In this retrospective study, 104 consecutive patients with TCP who underwent pericardiectomy were classified into calcification (n=34) and non-calcification (n=70) groups based on preoperative cardiac CT. Clinical data, laboratory results, echocardiographic parameters, and CT imaging variables were compared between groups. The impact of various pericardial calcification indicators on early postoperative adverse outcomes (a composite of low cardiac output syndrome or in-hospital mortality) was analyzed. Multivariate linear regression was performed to identify factors independently associated with the duration of postoperative intensive care unit (ICU) stay. Results: Patients with pericardial calcification had a longer disease duration, more severe bilateral atrial enlargement, greater dilation of the venae cavae, and a higher peak early diastolic mitral inflow velocity (E), alongside significantly lower C-reactive protein (CRP) levels and less pericardial thickening (all P<0.05). Postoperatively, both groups showed decreases in peak early diastolic mitral annular velocity (e'), ventricular septal bounce incidence, and left atrial (LA) size compared to preoperative values (all P<0.05). There were no significant differences in various pericardial calcification indicators between patients with and without early postoperative adverse outcomes (all P>0.05). Multivariate linear regression analysis identified ejection fraction (EF) (β=-0.278, P=0.004) and the presence of pleural effusion (β=0.205, P=0.037) as independent correlates of postoperative ICU stay, whereas the extent of pericardial calcification [ln(calcium score +1)] (β=-0.062, P=0.558) showed no independent association. Conclusions: Pericardial calcification in TCP signifies a chronic disease state, characterized by attenuated inflammation but more pronounced cardiac remodeling and diastolic dysfunction. However, it is not associated with an increased risk of early adverse outcomes nor with the duration of postoperative ICU stay after pericardiectomy.