DISCUSSION
CP may be caused by various factors, some of which may be transient, while TBCP may manifest as a progressive constriction even treated. Although idiopathic, post-cardiac surgery and radiation were the three most common etiologies of CP in some developed countries. Considering the high incidence of TBP in developing countries, the prevalence of MDR-TB, the impact of HIV, T2DM, obesity and some national policies, TB will still be the main cause of CP for a long time worldwide.
Constriction is the end-stage manifestation of TBP, which contributes to the death of patients with TBP. Early Diagnosis and treatment of TBCP are crucial for prognosis. As we have known that TBP has four pathological stages-dry, effusive, absorptive, and constrictive. However, many patients with TBCP who give no history of an acute attack have in fact had such an attack, which has been overlooked because of the mildness of the constitutional symptoms. For these patients, it is still controversial whether the constriction results from the progression of acute pericarditis from a dry stage sequentially through an effusive, absorptive and constrictive phase[71,72]. Moreover, when it progresses to chronic constriction, the etiologic Diagnosis may be more impossible and the treatment only left pericardiectomy. Limited by the fibrosis pericardium for a long time, the myocardial function may be impaired. The perioperative mortality rate is high even with extracorporeal circulation while calcification has penetrated the myocardium causing a reconstruction of the heart.
To date, little progress has made in our understanding of the immunopathogenesis of TBCP, especially accompanied by HIV, T2DM, and obesity. Neither a relatively inexpensive, rapid, accurate, and widely available test has been developed, nor the determinants and drivers of TBCP have been understood, much less is the pharmacokinetics and pharmacodynamics of anti-tuberculous drugs in both plasma and the pericardium and their impact on short- and long-term outcomes. Therefore, there seems to be a long way to go[73].