Prognostic value of echocardiography in hospitalized patients with pericardial effusion (original) (raw)
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Iranian Heart Journal, 2020
Background: Cardiac tamponade nearly always requires urgent intervention, but the optimal management of pericardial effusion is still controversial. The aim of our study was to introduce the profile and treatment results of patients with tamponade in our referral heart center. Methods: From November 2010 to November 2014, our retrospective study was performed on 220 patients with tamponade. All the clinical and echocardiographic findings of the patients, as well as their operative and follow-up data, were recorded and analyzed. Results: The overall prevalence of tamponade relative to the entire study population undergoing heart surgery was 8.5%. There were 106 men and 114 women at a mean age of 55.5 years (range = 5-99). The most common causes of tamponade were cardiac diseases (21%), malignancy (20.4%), unknown (20.4%), chronic renal failure (15%), and post-cardiac surgery complications (10.5%). The approaches for pericardial effusion drainage were the subxiphoid approach (97.7%), mini-thoracotomy (1.4%), and percutaneous pericardiocentesis (0.9%). The intraprocedural mortality rate was zero, the mortality rate during hospital stay was 4.5%, and the recurrence rate was 9.1%. Patients with primary sanguineous pericardial effusion, malignant etiologies of tamponade, and malignant pericardial effusion had significantly poor survival. The survival rates at 1 month, 1 year, 2 years, and 3 years were 87.1%, 67.7%, 64.5%, and57.2%, respectively. Conclusions: We found an association between left pleural effusion and small amounts of pericardial effusion, hence the necessity of more attention in the echocardiographic evaluation of these patients. The subxiphoid approach for pericardial effusion drainage is a safe and simple procedure associated with relatively lower postoperative complications, mortality, and recurrence rate. Sanguineous pericardial effusion is concomitant with poor prognoses.
ESC CardioMed, 2018
Pericardial effusion is classified according to its onset—acute, subacute, or chronic (>3 months)—distribution (circumferential or loculated), and haemodynamic impact. Concerning the size, we propose a simple semiquantitative echocardiographic assessment: mild (<10 mm), moderate (10–20 mm), and large (>20 mm), evaluated as the largest telediastolic echo-free space in two-dimensional mode. Symptoms vary according to the speed of accumulation; slow accumulation may induce no or minor symptoms. In the presence of chronic, large pericardial effusions, appropriate tests for neoplasms, tuberculosis, and hypothyroidism should be considered. Chest computed tomography scanning is helpful in reaching an aetiological diagnosis (neoplasms, lymphomas, pneumonia, tuberculosis). High values of proteins, albumin, and lactate dehydrogenase are usually considered indicative of an exudate, as in pleural fluid, but this may not be true for pericardial fluid, and cytology has a sensitivity of o...
Quantification of Pericardial Effusions by Echocardiography and Computed Tomography
The American Journal of Cardiology, 2011
Echocardiography is a well-accepted tool for the diagnosis and quantification of pericardial effusion (PEff). Given the increasing use of computed tomographic (CT) scanning, more PEffs are being initially diagnosed by computed tomography. No study has compared quantification of PEff by computed tomography and echocardiography. The objective of this study was to assess the accuracy of quantification of PEff by 2-dimensional echocardiography and computed tomography compared to the amount of pericardial fluid drained at pericardiocentesis. We retrospectively reviewed an institutional database to identify patients who underwent chest computed tomography and echocardiography before percutaneous pericardiocentesis with documentation of the amount of fluid withdrawn. Digital 2-dimensional echocardiographic and CT images were retrieved and quantification of PEff volume was performed by applying the formula for the volume of a prolate ellipse, ؋ 4/3 ؋ maximal long-axis dimension/2 ؋ maximal transverse dimension/2 ؋ maximal anteroposterior dimension/2, to the pericardial sac and to the heart. Nineteen patients meeting study qualifications were entered into the study. The amount of PEff drained was 200 to 1,700 ml (mean 674 ؎ 340). Echocardiographically calculated pericardial effusion volume correlated relatively well with PEff volume (r ؍ 0.73, p <0.001, mean difference ؊41 ؎ 225 ml). There was only moderate correlation between CT volume quantification and actual volume drained (r ؍ 0.4, p ؍ 0.004, mean difference 158 ؎ 379 ml). In conclusion, echocardiography appears a more accurate imaging technique than computed tomography in quantitative assessment of nonloculated PEffs and should continue to be the primary imaging in these patients.
Erciyes Medical Journal, 2021
The purpose of this study was to determine the etiology in 100 tertiary care patients who underwent pericardiocentesis in the last 5 years due to cardiac tamponade or large pericardial effusion (floating heart) through retrospective analysis of their echocardiographic findings, biochemical and cytological test results, and imaging methods. Materials and Methods: The records of 100 patients who underwent pericardiocentesis in 2014-2019 due to pericardial effusion were reviewed retrospectively. Their etiology was determined by recording their echocardiograms, biochemical test results, imaging results, and those of laboratory tests performed on pericardial fluid, culture, and cytology results. All data of the patients were recorded and analyzed. Results: Cardiac tamponade was the most common reason (77%) for pericardiocentesis performed in the patients in the study group. Of the drained effusions, 56% were macroscopically hemorrhagic. The most common etiology was associated with idiopathic causes by 32%. Malignancy was found only in 44.6% of the hemorrhagic effusions. Cytological examination revealed 83% benign findings. Only 58.6% of the patients with malignancy were found to have malignant cells in their cytological tests. Conclusion: The most common cause was idiopathic in the patients for whom pericardiocentesis was indicated in our study group. Nearly half of the macroscopically hemorrhagic effusions had malignancy. Half of the patients who developed effusion due to malignancy were found to have malignant cells in cytological tests. This study differs from other studies conducted in Turkey because it included a higher number of patients and its results are important to guide our daily practice.
Relation of Blood Pressure to Severity of Pericardial Effusion
The American journal of cardiology, 2018
Subacute tamponade is a challenging diagnosis requiring careful consideration of both clinical and imaging data. We aimed at exploring the association of initial blood pressure with markers of pericardial effusion severity in patients with moderate and large pericardial effusion. We conducted a retrospective, single-center study in 102 well-phenotyped patients with moderate and large pericardial effusion. The presenting systolic and diastolic blood pressure recordings were divided into tertiles to examine the association between the blood pressure and the different established markers of pericardial effusion severity. On presentation, 42% of patients had systolic blood pressure exceeding 130 mm Hg, and only 5% of patients had systolic blood pressure <90 mm Hg. Patients in the lowest blood pressure tertiles did not differ significantly from patients in the upper tertiles in terms of clinical, etiologic, or echocardiographic characteristics. Although patients who underwent pericard...
Objective: Clinical and echocardiographic features of significant pericardial effusion (PE) have been reported from the west. Currently there is lack of published data from this part of the world, we reviewed all consecutive cases of significant PE requiring echocardiographic assisted pericardiocentesis to analyze the clinical and echocardiographic features of these patients. Methods: Forty four consecutive patients who underwent echocardiography assisted pericardiocentesis at the Aga Khan University Hospital (AKUH) between January 1988 and May 2001 are included in this review. Results: Most common presenting symptoms were dyspnea (89%) and fever (36%). Elevated JVP and pulsus paradoxus were documented in 59% and 41% of patients respectively. Sinus tachycardia (75%) and low voltage (34%) were the most common ECG findings. Malignancy (45-51%) and tuberculosis (27%) were among the most frequent causes of PE. One patient died during echocardiography-assisted pericardiocentesis. Conclusion: The symptoms and physical findings of haemodynamically significant PE are frequently nonspecific. Transthoracic echocardiography is the gold standard for rapid and confirmatory diagnosis of PE and cardiac tamponade. The most common cause of PE was malignancy followed by tuberculosis. Pericardiocentesis under echocardiographic guidance is a safe and effective treatment for significant PE (JPMA 55:66;2005).