Abstract Body (Do not enter title and authors here): Background: Two-dimensional speckle tracking echocardiographic (2D-STE) strain analysis is modern and inovatively useful in overcoming technical echocardiographic limitations. To-date no larger studies have assessed sub-clinical myocardial mechanics in acute tuberculous pericarditis (ATBP) and age/sex/ethnic differences, and synergistic-prognostic association of these parameters with patients' outcomes (survival).
Aim: To assess the prognostic relation between age/sex/ethnitic differences with right (RV) and left (LV) ventricular systolic and diastolic strain (and other parameters/biomarkers) with outcome ATBP and preserved LV function.
Methods and results: A total of 362 (mean age 37years, LVEF 56%, 57% males) consecutive patients with ATBP were enrolled and subseguently had 2D-STE strain analysis performed on their the 2D-TTE images. Sex, age and ethnic differences were assessd and all were prospectively followed for new CVS events including new onset acute heart failure or deterioration in LV function, hospitalization for HF, CVS-related death, recurrent effusion or tamponade.
The LV and RV longitudinal strain parameters were assessed using the 2D-STE. Of the 362 patients eligible for the study, 142 developed 84 new CVS-related events during a mean follow-up of 12 ±6 months. The RV free-wall, global RV and LV systolic and diastolic strain parameters, elevated NT Pro-BNP and troponins, RV fractional area change, low TAPSE, LV end-diastolic volume, LA volume index, moderate TR, and mPASP > 40mmHg were independently predictive of combined outcomes (p <.0001). ATBP demonstrated impaired RV>LV strain parameters and best performance predictive of CVS events was greatest for RV compared with LV strain. There was a stronger association between the degree of RV dysfunction and risk of CVS events for RV free wall- and global systolic and diastolic strain parameters and biomarker compared with LV strain parameters. Male sex, older age (at least 42years) and black etnicity were further independent risk factors of outcomes.
Conclusion: Patients with ATBP and normal LVEF, and myocardial mechanical dysfunction in addition to elevated biomarkers were stronger predictors of outcome more so for those with RV dysfuntion than other conventional and LV mechanical parameters. Male sex, older age and black ethnicity provided additional independent risk of outcomes in ATBP, providing stronger prognostic stratification.