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Original research article
Disparity in spatial distribution of pericardial calcifications in constrictive pericarditis
  1. Alpana Senapati1,
  2. Hussain A Isma’eel2,
  3. Arnav Kumar3,
  4. Ayman Ayache3,
  5. Chandra K Ala3,
  6. Dermot Phelan3,
  7. Paul Schoenhagen4,
  8. Douglas Johnston5 and
  9. Allan L Klein6
  1. 1 Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
  2. 2 Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
  3. 3 Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
  4. 4 Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
  5. 5 Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
  6. 6 Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic , Heart and Vascular Institute, Cleveland, Ohio, USA
  1. Correspondence to Dr Allan L Klein; kleina{at}


Background Pericardial calcification is seen among patients with constrictive pericarditis (CP). However, the pattern of pericardial calcium distribution and the association with clinical outcomes and imaging data are not well described.

Methods This was a retrospective study from 2007 to 2013 to evaluate the pattern of pericardial calcium distribution by CT in CP using a semiquantitative calcium scoring system to calculate total pericardial calcium burden and distribution. Calcium localisation was allocated to 20 regions named after the corresponding heart structure. Baseline clinical data, imaging data and clinical outcomes were collected and compared between the calcified pericardium and non-calcified pericardium groups. We assessed the effect of pericardial calcium on clinical outcomes and echocardiographic data between the two groups.

Results Of the 123 consecutive patients with CP (93 male; mean age 61±13 years) between 2007 and 2013, 49 had calcified pericardium and 74 had non-calcified pericardium. Distribution of calcium on the left ventricle (LV) basal anterior, mid-anterior and apical segments in addition to right ventricle (RV) apical segment was involved in <30% of the cases with the remaining segments involved in >35% of cases. A potential protective role of RV calcium on regional myocardial mechanics was noted.

Conclusion Preferential distribution of calcium in CP in a partial band-like pattern (from basal anterolateral LV going inferiorly and then encircling the heart to reach the RV outflow tract) with extension into the mitral and tricuspid annuli was noted. Pericardial calcium was not significantly associated to clinical outcomes.

  • constriction
  • pericarditis
  • CT scanning

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  • AS and HAI contributed equally.

  • Contributors AS and HAI contributed equally to this study and drafted the manuscript. AS, HAI, AK, AA, CKA and ALK participated in the study design and data collection. DP, PS, DJ and ALK critically reviewed the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Cleveland Clinic Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data statement The data is secure and confidential and can be only accessed through the Cleveland Clinic pericardial database.

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