Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website https://cr.elmerpub.com

Original Article

Volume 17, Number 3, June 2026, pages 239-247

The Role of High-Mobility Group Box 1/Toll-Like Receptor 4 in Pericardial Fibrosis and Postoperative Low Cardiac Output Syndrome in Constrictive Pericarditis

Figures

↓  Figure 1. Hematoxylin and eosin (H&E) stained sections of patients with chronic constrictive pericarditis. (a, b) Microscopic findings of pericardial tissue sections from patients with nonspecific pericarditis (scale bars = 500 µm for both). (c, d) Microscopic findings of pericardial tissue sections from patients with tuberculous pericarditis (scale bars = 1 mm and 250 µm, respectively).
Figure 1.
↓  Figure 2. Expression of α-SMA in pericardial tissue from different patients (scale bars = 100 µm for all panels). α-SMA: α-smooth muscle actin.
Figure 2.
↓  Figure 3. Expression of Col-III in pericardial tissue from different patients (scale bars = 100 µm for all panels). Col-III: collagen III.
Figure 3.
↓  Figure 4. Expression of TLR4 in pericardial tissue from different patients (scale bars = 100 µm for all panels). TLR4: toll-like receptor 4.
Figure 4.
↓  Figure 5. Expression of HMGB1 in pericardial tissue from different patients (scale bars = 100 µm for all panels). HMGB1: high-mobility group box 1.
Figure 5.
↓  Figure 6. Association between TLR4, HMGB1 and α-SMA. TLR4: toll-like receptor 4; α-SMA: α-smooth muscle actin; HMGB1: high-mobility group box 1.
Figure 6.
↓  Figure 7. Expression of TLR4 and HMGB1 in patients with and without postoperative LCOS. LCOS: low cardiac output syndrome; TLR4: toll-like receptor 4; HMGB1: high-mobility group box 1.
Figure 7.
↓  Figure 8. ROC curve of TLR4 (a) and HMGB1 (b) for predicting postoperative LCOS. LCOS: low cardiac output syndrome; TLR4: toll-like receptor 4; HMGB1: high-mobility group box 1; ROC: receiver operating characteristic; AUC: area under the curve; CI: confidence interval; FPR: false positive rate.
Figure 8.

Table

↓  Table 1. Clinical Characteristics of the Study Population
 
VariablesN = 24
Values presented as n (percentage) for categorical variables and median (range) for continuous variables. NYHA: New York Heart Association; BMI: body mass index; CVP: central venous pressure; LVEF: left ventricular ejection fraction (measured on echocardiogram); LCOS: low cardiac output syndrome.
Age, years65.5 (18.0–83.0)
Sex
  Male18 (75.0%)
  Female6 (25.0%)
Etiology
  Tuberculosis22 (91.7%)
  Idiopathic2 (8.3%)
NYHA functional class
  I0 (0%)
  II10 (41.7%)
  III11 (45.8%)
  IV3 (12.5%)
BMI, kg/m221.7 (15.6–31.5)
CVP, cm H2O24.0 (16.0–36.4)
Pericardial thickness, mm8.6 (3.5–18.4)
LVEF, %58.3 (42.0–68.6)
Postoperative LCOS7 (29.2%)