Publication date: Sep 20, 2025

Constrictive pericarditis is a rare but serious complication of pericardial disease, with limited longitudinal studies assessing risk factors. We evaluated the epidemiology and predictors of constrictive pericarditis in a large population-based cohort. We conducted a retrospective cohort study of all hospitalized patients with pericardial disease from 2004-2021 using the Australian New South Wales Admitted Patient Data Collection database. Multivariable logistic regression identified risk factors for constrictive pericarditis at index admission with pericardial disease, while time-dependent Cox regression and Fine and Gray’s method assessed risk factors during follow-up. Among 45445 patients with pericardial disease, 763 (1. 7%) developed constrictive pericarditis (median age 64. 3 years; 63. 4% male). The median time from cardiac surgery to diagnosis of constriction was 6 months and from autoimmune disease diagnosis was 2 years. Of these, 530 (1. 2%) had constriction at index presentation of pericardial disease and 233 (0. 5%) developed constriction during follow-up. Constriction at index presentation was associated with older age, malignancy (odds ratio [OR]=1. 5, 95% confidence interval [CI]=1. 2-1. 8), tuberculosis (OR=3. 9, 95%CI=1. 4-8. 9), liver disease (OR=1. 7, 95%CI=1. 3-2. 2) and heart failure (OR=2. 7 95%CI=2. 2-3. 3). Constriction identified during follow up was more common following hospitalization for heart failure (hazard ratio [HR]=5. 3, 95%CI=3. 4-8. 2), non-constrictive recurrent pericardial disease requiring hospitalization (HR=3. 7, 95%CI=2. 3-6. 2) or pericardiocentesis (HR=3. 6, 95%CI=2. 7-4. 8). In this large contemporary cohort, constrictive pericarditis was rare but occurred more commonly after a diagnosis of tuberculosis, malignancy, liver disease, heart failure, recurrent pericardial disease and pericardiocentesis. These findings highlight the importance of long-term vigilance in considering constriction in at-risk populations.

Semantics

Original Article