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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 5, September/October 2019
AFRICA
253
strength of association (odds ratios) between the explanatory
predictors and HIV status. A
p
-value of
<
0.05 was considered
statistically significant.
Results
Pre-operative clinical profile
A total of 86 patients were eligible for inclusion during the
study period (Fig. 1). Three patients were excluded, (incorrect
diagnosis:
n
=
2, HIV status unknown:
n
=
1) leaving 83 (43 male,
40 female) for analysis. The mean age of the total sample was
37.98
±
12.91 years (range 19–69). Of these patients, 32 (38.6%)
were HIV positive, of whom 21 (65.6%) were on antiretroviral
therapy, and of these, 19 (59%) patients were virally suppressed
(viral load
<
1 000 copies/ml). Three patients who were not on
antiretroviral therapy had viral loads
<
1 000 copies/ml. In total
8/32 (25.0%) patients had a CD4 count of less than 200 cells/
mm
3
. The baseline characteristics stratified by HIV status are
shown in Table 1
.
The aetiology of constriction was tuberculosis in 80/83
(96.3%) patients. Constriction was deemed to have followed
viral pericarditis in two patients and the third developed
constriction following repeated radio-ablation procedures for
tachyarrhythmias. Tuberculosis was proven in 22 (26.5%) patients
and was considered the probable aetiology in a further 58 (69.5%)
patients. Although proven tuberculosis was identified more
frequently in HIV-positive (40%) compared to HIV-negative
patients (17.6%), this finding was not statistically significant.
The mean body weight of HIV-positive patients was 5 kg less
those who were HIV negative (62.77
±
12.01 vs 67.69
±
13.05 kg;
p
=
0.09) but this finding was also not statistically significant.
Moderate dyspnoea (NYHA class II) was present in almost
two-thirds (63.9%) of the patients and severe symptoms were
present in 32.5% (NYHA class III and IV) of patients. Similarly,
two-thirds (
n
=
57; 68.7%) of patients had ascites. There was no
difference in the clinical characteristics between HIV-positive
and -negative patients except for peripheral oedema, which
was significantly more frequent in HIV-negative patients (86.2
vs 65.6%;
p
=
0.026). Atrial fibrillation was documented in
five patients (all HIV negative), four of whom had extensive
pericardial calcification on chest radiography.
Allpatients(
n
=
83)hadchestradiographsandechocardiograms
and 77 (94%) had thoracic CT scans. A total of 17 patients
(20.5%) had pericardial calcification on the chest radiograph
and one additional patient had pericardial calcification identified
on CT scan only. Extensive pericardial calcification was more
common on the chest radiograph in HIV-negative compared
to HIV-positive patients (
n
=
15, 29.4 vs
n
=
2, 6.3%;
p
=
0.011). Mediastinal lymphadenopathy was identified in 47 (61%)
patients and there was no difference between HIV-positive and
-negative patients (
p
=
0.642)
On echocardiography, effusive constrictive pericarditis was
found in seven (8.4%) patients, of whom four were HIV negative
and three HIV positive. There was no significant difference in
the ejection fraction (51.88
±
7.5 vs 52.69
±
4.96%;
p
=
0.593)
and pulmonary arterial pressure (33.88
±
8.86 vs 34.96
±
7.76
mmHg;
p
=
0.571) between HIV-negative and -positive patients,
respectively.
Laboratory data showed no significant differences in
haemoglobin, white cell count, urea, creatinine and albumin
Table 1. Baseline characteristics of study patients stratified by HIV status
Characteristics
All
(
n
=
83)
HIV negative
(
n
=
51)
HIV positive
(
n
=
32)
p
-valve
Age (years)
37.98
±
12.91 38.82
±
14.56 36.63
±
14.56 0.454
Weight (kg)
65.75
±
12.81 67.69
±
13.05 62.77
±
12.01 0.91
Gender
4.24
Male
43(51.8)
29 (56.9)
14 (43.75)
Female
40 (78.2
22 (43.1)
18 (56.35)
Aetiology of pericarditis
0.140
Probable tuberculosis
58 (69.9)
39 (76.5)
19 (59.4)
Proven tuberculosis
22 (26.5)
9 (17.6)
13 (40.6)
Other
3 (3.6)
3 (5.9)
0
NYHA functional class
0.481
l
3 (3.6)
2 (3.9)
1 (3.1)
ll
53 (63.9)
33 (64.7)
20 (62.5)
lll
22 (26.5)
4 (7.8)
1 (3.1)
lV
5 (6.0)
4 (7.8)
1 (3.1)
Examination
SBP (mmHg)
110.83
±
11.85 110.78
±
11.67 110.91
±
12.32 0.963
DBP (mmHg)
70.57
±
10.63 71.43
±
9.86 69.19
±
11.78 0.352
Pulse rate (beats/min) 88.76
±
14.72 86.35
±
14.74 92.59
±
14.05 0.060
Jugular vv pressure
77 (92.8)
48 (94.1)
29 (90.6)
0.358
Pericardial knock
43 (51.8)
24 (47.1)
19 (59.4)
0.274
Hepatomegaly
76 (91.6)
46 (90.2)
30 (93.8)
0.767
Ascites
57 (68.7)
35 (68.3
22 (68.8)
0.991
Oedema
65 (78.3)
44 (86.2)
21 (65.6)
0.026
Chest X-ray
Pericardial calcifica-
tion
17 (20.5)
15 (29.2)
2 (6.3)
0.011
Pleural effusion
67 (80.7)
43 (84.3)
24 (75.0)
0.295
Echocardiography
Ejection fraction (%)
52.19
±
6.61 51.88
±
7.50 52.69
±
4.96 0.593
End-diastolic dimen-
sion
47.95
±
7.793 47.4
±
7.92 48.81
±
8.01 0.435
Left atrial size (mm)
43.85
±
8.57 44.86
±
9.5 42.28
±
6.70 0.185
Septal bounce
81 (97.6)
49 (96.1)
32 (100.0)
0.257
PA pressure (mmHg)
34.31
±
8.41 33.88
±
8.86 34.96
±
7.76 0.571
Dilated IVC/hepatic vv 73 (97.3)
45 (100.0)
28 (93.3)
0.157
CT chest
Pleural effusion
58 (75.3)
37 (80.4)
21 (67.7)
0.282
Pericardial thickening 73 (94.8)
45 (97.8)
28 (90.3)
0.297
Pericardial calcification 18 (23.4)
15 (32.6)
3 (9.7)
0.032
Lymphadenopathy
47 (61.0)
27 (58.7)
20 (64.5)
0.64
Laboratory results:
mean
±
SD
Haemoglobin (g/dl)
12.78
±
1.75 12.91
±
1.76 12.58
±
1.74 0.418
White cell count (10
9
cells/l)
5.15
±
1.47
5.25
±
1.48 4.99
±
1.46
0.444
Platelets (10
12
cells/l)
251.86
±
84.37 244.20
±
79.82 264.06
±
91.11 0.299
Sodium (mmol/l)
136.96
±
3.33 137.27
±
3.50 136.47
±
3.03 0.286
Urea (mmol/l)
60.58
±
2.57 6.40
±
2.79 6.86
±
2.20
0.286
Creatinine (µmol/l)
81.70
±
20.57 81.76
±
20.05 81.59
±
21.55 0.971
Albumin (g/l)
37.60
±
6.33 38.04
±
5.99 36.91
±
6.89 0.431
AST (U/l)
39.35
±
13.59 37.22
±
10.51 42.28
±
16.69 0.110
ALT (U/l)
25.21
±
16.94 20.71
±
10.70 32
±
22.06
0.002
Alkaline PO
4
(U/l)
167.40
±
89.50 146.02
±
67.70 201
±
108.82 0.005
Gamma GT (U/l)
249.16
±
224.09 172.96
±
104.76 370
±
300.59
<
0.001
Data presented as mean
±
standard deviation for continuous variables and
n
(%)
for categorical variables. NYHA, New York Heart Association; SBP, systolic blood
pressure; DBP, diastolic blood pressure; PA pressure, pulmonary artery pressure;
IVC, inferior vena cava; CT, computed tomography; AST, aspartate aminotransfer-
ase; ALT, alanine aminotransferase; alkaline PO
4
, alkaline phosphatase; gamma GT,
gamma glutamyl transferase.
CT scanning was not undertaken in six subjects (five HIV-negative and one HIV-
positive subject).
No results for dilated IVC and hepatic veins for eight subjects (six HIV-negative and
two HIV-positive subjects).