BACKGROUND: We aimed to compare computed tomography (CT)-derived myocardial strain between patients with constrictive pericarditis (CP) and a matched healthy control group and to identify factors associated with clinical outcomes after pericardiectomy. METHODS: This retrospective study included 65 patients with CP (mean age: 58.9 ± 8.0 years) and 65 healthy individuals (mean age: 58.0 ± 6.5 years) who underwent multiphase cardiac CT. The type of CP was classified as calcified CP or fibrotic CP. CT-derived strains from four cardiac chambers were compared between the CP and control groups, as well as between different types of CP. Clinical and CT-derived factors associated with adverse outcomes were identified using Cox regression analysis. RESULTS: Compared with the control group, the CP group showed significantly lower values of left atrium (LA) reservoir strain (15.7 % vs. 27.4 %), right atrium (RA) reservoir strain (15.1 % vs. 27.0 %), left ventricle (LV) global longitudinal strain (GLS) (-17.0 % vs. -19.5 %), and right ventricle free wall longitudinal strain (-21.1 % vs. -25.9 %) (all p <
0.001). Biatrial reservoir strains and LV GLS were significantly lower in those with calcified CP compared to those with fibrotic CP. LA reservoir strain (hazard ratio, 0.91-95 % confidence interval, 0.86-0.96- p = 0.001) was an independent prognostic factor for adverse events in patients with CP. CONCLUSION: Cardiac strain differences in CP were predominantly observed in the LA and RA compared to the healthy control group. Biatrial reservoir strains were specifically impaired in those with calcified CP than in those with fibrotic CP. LA reservoir strain was associated with prognosis in patients with CP following pericardiectomy.