Cardiovascular magnetic resonance characterisation of pericardial and myocardial involvement in patients with tuberculous pericardial constriction with and without HIV co-infection

Background Tuberculosis pericarditis (TBP) is the most common cause of a large pericardial effusion in the developing world, accounting for 70% of effusions in a case series from South Africa; and has a high mortality related to pericardial tamponade, constrictive pericarditis, arrhythmias and heart failure. Manifestations of TBP include pericarditis with pericardial effusion, effusive-constrictive and constrictive pericarditis. There has been a dramatic resurgence in TBP in the context of co-infection with the human immunodeficiency virus (HIV). Almost 100% of pericardial effusions in those infected with HIV in sub-Saharan Africa are due to tuberculosis, compared with 50-70% in those HIV-uninfected and less than 5% in industrial nations. In patients with TBP, co-infection with HIV is associated with increased heart failure, haemodynamic instability, electrocardiographic (ECG) ST elevation and mortality, suggesting an aggressive myopericarditis in the context of HIV co-infection. However, little is known about myocardial involvement in patients with TBP. Cardiovascular magnetic resonance (CMR) can assess non-invasively cardiac function, myocardial oedema, inflammation and fibrosis. We hypothesised that HIV co-infection would be associated with increased myocardial pathology on CMR in patients with TBP.