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Myopericarditis in tuberculous pericardial effusion: prevalence, predictors and outcome
  1. Faisal F Syed1,
  2. Mpiko Ntsekhe2,
  3. Freedom Gumedze3,
  4. Motasim Badri2,4,
  5. Bongani M Mayosi2
  1. 1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Department of Medicine, The Cardiac Clinic, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
  3. 3Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
  4. 4King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
  1. Correspondence to Dr Faisal F Syed, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905 USA; syed.faisal{at}mayo.edu

Abstract

Objective The prevalence, predictors and outcome of myopericarditis in patients with tuberculous (TB) pericarditis are unknown.

Methods Eighty-one patients (mean age±SD, 36.1±13.3 years; 54 (66.7%) men; 58 (71.6%) HIV seropositive) with TB pericarditis were recruited between January 2006 and September 2008. Myopericarditis was defined as echocardiographic LV systolic dysfunction (immediately after pericardiocentesis), elevated peripheral blood troponin T (>0.03 ng/mL), or elevated peripheral blood creatine kinase (CK >174 IU/L) with a CK:CK-myocardial band (MB) mass ratio of >6%. The outcome measure was case fatality rate at 6 months of follow-up.

Results Myopericarditis was present in 43 (53.1%) patients. Patients with myopericarditis, as compared with those without, were more likely to be HIV seropositive (35 (81.4%) vs 23 (60.5%) respectively, p=0.038) and have lower peripheral CD4 count (median (IQR) 98 (54–290) vs 177 (104–429), p=0.026). Electrocardiographic ST segment elevation was more common in myopericarditis (15 (36.6%) vs 4 (10.8%), p=0.008) and predicted myopericarditis independently of CD4 count on multiple logistic regression analysis (OR 4.36, 95% CI 1.34 to 17.34, p=0.0132). At 6 months, 14 (18%) patients had died with no significant difference between those with or without myopericarditis (6/42 (14%) vs 8/36 (22%), respectively (p=0.363)).

Conclusions Myopericarditis is common in TB pericardial effusion and associated with HIV-related immunosuppression. It can be identified by electrocardiographic ST-elevation, particularly when peripheral CD4 count is low. There was no significant difference in case fatality rate in those with or without myopericarditis.

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