Abstract 4336121: Clinical and Echocardiographic Determinants of Prognosis in Tuberculous Pericarditis

Background: Tuberculous pericarditis (TBP) remains a significant cause of morbidity and mortality, particularly in regions where tuberculosis is endemic. While clinical presentation varies, the prognostic impact of demographic characteristics and echocardiographic parameters in TBP has not been comprehensively evaluated at scale. Objective: To determine the prognostic implications of demographic and echocardiographic features in a cohort of 668 patients diagnosed with tuberculous pericarditis. Methods: We conducted a retrospective analysis of 668 patients with confirmed TBP across multiple centers. Demographic data including age, sex, and HIV status were collected alongside echocardiographic parameters such as pericardial effusion size, presence of cardiac tamponade, ventricular function, and features suggestive of constrictive pericarditis. Clinical outcomes were evaluated over a defined follow-up period of 2years, focusing on mortality, progression to constriction, and need for pericardiectomy. Results: Among the 668 patients, median age was 37 years, and 57% were male (mean LVEF 56%). HIV co-infection was present in 36% of cases. Echocardiography revealed moderate to large pericardial effusions in 32% of patients, tamponade in 12%, and echocardiographic features of constriction in 23%. Multivariate analysis identified older age, HIV co-infection, large effusion size, and early echocardiographic evidence of constriction as independent predictors of adverse outcomes (p < 0.05). Preserved ventricular function was associated with improved survival, while reduced systolic performance, although uncommon, indicated a higher risk of mortality. Conclusion: In this large, predominantly young cohort of patients with tuberculous pericarditis, demographic factors, particularly age and HIV status alongside echocardiographic parameters such as effusion size, ventricular function, and signs of constriction were strong independent predictors of adverse outcomes. These findings support the integration of focused echocardiographic assessment with clinical profiling to guide early risk stratification, therapeutic decisions, and surgical referral in TBP, especially within high-burden, resource-constrained environments. Risk stratification using these indicators may inform early management decisions and improve patient outcomes.