Abstract Body (Do not enter title and authors here): Background:
Tuberculous pericarditis (TBP) remains a life-threatening extrapulmonary manifestation of tuberculosis (TB), particularly in regions with high TB prevalence. It often presents with pericardial effusion, cardiac tamponade, or progression to constrictive pericarditis (CP) and even hemodynamic compromise. While echocardiographic assessment of ventricular function is well established and left ventricular ejection fraction (LVEF) frequently preserved, subtle myocardial dysfunction may go undetected without advanced imaging. The prognostic role of atrial strain abnormalities, particularly left atrial (LA) and right atrial (RA) reservoir strain remains inadequately defined and underexplored.
Objective:
This study evaluates the prognostic implications of LA and RA strain abnormalities in patients with TBP, assessing their association with clinical outcomes and disease progression.
Methods:
A retrospective, multicenter study was conducted in 668 patients with confirmed TBP, (mean age = 37 years, mean LVEF= 56%, 57% male). All patients underwent comprehensive echocardiographic assessment, including two-dimensional speckle-tracking echocardiography for LA and RA reservoir strain analysis. Clinical outcomes were tracked over a defined follow-up period of 2-years. Multivariate Cox regression models were used to determine independent predictors of MACE.
Results:
Impaired LA and RA reservoir strain were observed in a significant proportion of patients despite preserved LVEF. Patients with reduced atrial strain values had higher rates of CP (p < 0.01), RV failure (p < 0.01), and all-cause mortality (p = 0.02). RA strain abnormalities were particularly associated with RV dysfunction and adverse hemodynamic profiles. Inflammatory markers (CRP, ESR) were significantly elevated in patients with atrial strain impairment, suggesting ongoing pericardial inflammation. In multivariate analysis, reduced LA and RA reservoir strain independently predicted MACE, even after adjusting for age, sex, HIV status, effusion size, and baseline ventricular function.

Conclusion:
In TBP, LA and RA strain abnormalities serve as sensitive indicators of subclinical cardiac dysfunction and strong independent predictors of adverse outcomes, including progression to constriction and death. These findings underscore the value of atrial strain imaging in early risk stratification and highlight the need for timely therapeutic intervention in those with strain abnormalities, even with preserved LVEF.