Clinical features and factors affecting in-hospital mortality of patients who underwent pericardiocentesis due to moderate to severe pericardial effusion

Objectives: The aim of this study was to determine the primary etiology of pericardial effusion in patients undergoing percutaneous pericardiocentesis. Possible in-hospital mortality related predictors were also investigated. Patients and Methods: A retrospective analysis was made of the clinical and laboratory features of 268 patients who underwent pericardiocentesis due to moderate to severe pericardial effusion between January 2009 and March 2020. Results: The patients comprised 57.5% males and 42.5% females with a mean age of 62.3±15.4 years. Cardiac compression was detected in 220 (82.1%) patients, of which 208 (77.6%) were clinically tamponade and 12 (4.5%) were asymptomatic cardiac compression. The most common symptom was dyspnea (58.6%) and 10.8% of patients were asymptomatic. Pericardial fluid was exudate in 235 (87.7%) patients. The most common causes were malignancy (37.3%) followed by idiopathic (22.1%) and iatrogenic (12.7%) causes. The patients with asymptomatic cardiac compression were more likely to have malignant effusion than those with other etiologies (p=0.001). In-hospital mortality developed in 37 (13.8%) patients. The independent predictors of in-hospital mortality were determined as follows; etiology other than infectious or idiopathic (OR = 3.447; 95% CI = 1.266, 9.386; p = 0.015), and receiving antithrombotic therapy (OR = 2.306; 95% CI = 1.078, 4.932; p=0.031). Conclusion: Malignancy is the most common cause of moderate to severe pericardial effusions. The detection of cardiac compression in asymptomatic patients may be an important indicator of malignancy. Receiving antithrombotic therapy and having a non-idiopathic and non-infectious etiology may be predictors of in-hospital mortality.

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Prognosis and role of clinical and imaging features in patients with malignant pericardial effusion: a single-center study in China

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02331-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shucai Wang ◽

Jiazheng Zhao ◽

Chanchan Wang ◽

Ning Zhang

Keyword(s):

Pericardial Effusion ◽

Cardiac Tamponade ◽

Sinus Tachycardia ◽

Clinical Manifestations ◽

Common Symptom ◽

Cancer Type ◽

Imaging Features ◽

Factors Affecting ◽

Malignant Pericardial Effusion ◽

Echocardiographic Evidence

Abstract Background The diagnosis of malignant pericardial effusion (MPE) is often associated with a poor prognosis, but due to the complexity and unspecific nature of MPE patients' clinical manifestations, imaging often performs an essential role in diagnosis and prognosis. Methods Patients diagnosed with MPE between 2013 and 2018 at one tumor hospital were included and followed up. The data covered the basic clinical features, imaging findings, treatments and prognosis of patients with MPE, and the factors that may have affected the prognosis were explored. Results A total of 216 patients with MPE were included with the median age of 60 years. The most common primary cancer type was lung cancer (73.6%), the most common symptom was dyspnea (62.9%) and the most common abnormal electrocardiogram finding was sinus tachycardia (42.1%). The median survival time of the 216 patients with MPE was 13.7 months. The factors affecting prognosis were echocardiographic fluid signs (HR = 2.37, P = 0.010), electrocardiographic evidence of sinus tachycardia (HR = 1.76, P = 0.006) and echocardiographic evidence of cardiac tamponade (HR = 3.33, P < 0.001). Conclusions MPE has complex clinical manifestations and an unsatisfactory prognosis. Echocardiographic fluid signs, electrocardiographic evidence of sinus tachycardia, and echocardiographic evidence of cardiac tamponade are independent risk factors affecting prognosis.

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The Diagnostic Value of Pericardial Fluid and Pericardial Biopsy: Single Center Experiences

The Heart Surgery Forum ◽

10.1532/hsf.1328 ◽

2016 ◽

Vol 19 (1) ◽

pp. 023 ◽

Cited By ~ 2

Author(s):

Mehmet Yildirim ◽

Recep Ustaalioglu ◽

Murat Erkan ◽

Bala Basak Oven Ustaalioglu ◽

Hatice Demirbag ◽

...

Keyword(s):

Pericardial Effusion ◽

Thoracoscopic Surgery ◽

Pericardial Tamponade ◽

Pericardial Fluid ◽

Pathological Examination ◽

Common Disease ◽

Pericardial Window ◽

Surgical Interventions ◽

History Of ◽

Recurrent Pericardial Effusion

Background: Patients with recurrent pericardial effusion and pericardial tamponade are usually treated in thoracic surgery clinics by VATS (video-assisted thoracoscopic surgery) or open pericardial window operation. The diagnostic importance of pathological evaluation of the pericardial fluid and tissue in the same patients has been reported in few studies. We reviewed pathological examination of the pericardial tissue and fluid specimens and the effect on the clinical treatment in our clinic, and compared the results with the literature. Methods: We retrospectively analyzed 174 patients who underwent pericardial window operation due to pericardial tamponade or recurrent pericardial effusion. For all patients both the results of the pericardial fluid and pericardial biopsy specimen were evaluated. Clinicopathological factors were analyzed by using descriptive analysis. Results: Median age was 61 (range, 20-94 years). The most common benign diagnosis was chronic inflammation (94 patients) by pericardial biopsy. History of malignancy was present in 28 patients (16.1%) and the most common disease was lung cancer (14 patients). A total of 24 patients (13.8%) could be diagnosed as having malignancy by pericardial fluid or pericardial biopsy examination. The malignancy was recognized for 12 patients who had a history of cancer; 9 of 12 with pericardial biopsy, 7 diagnosed by pericardial fluid. Twelve of 156 patients were recognized as having underlying malignancy by pericardial biopsy (n = 9) or fluid examination (n = 10), without known malignancy previously. Conclusion: Recurrent pericardial effusion/pericardial tamponade are entities frequently diagnosed, and surgical interventions may be needed either for diagnosis and/or treatment, but specific etiology can rarely be obtained in spite of pathological examination of either pericardial tissue or fluid. For increasing the probability of a specific diagnosis both the pericardial fluid and the pericardial tissues have to be sent for pathologic examination.

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Malignant pericardial effusion complicated by cardiac tamponade under atezolizumab

SAGE Open Medical Case Reports ◽

10.1177/2050313x211036005 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110360

Author(s):

Lardinois Benjamin ◽

Goeminne Jean-Charles ◽

Miller Laurence ◽

Randazzo Adrien ◽

Laurent Terry ◽

...

Keyword(s):

Pericardial Effusion ◽

Cardiac Tamponade ◽

Cardiac Toxicity ◽

Checkpoint Inhibitors ◽

Final Diagnosis ◽

Pericardial Fluid ◽

Malignant Pericardial Effusion ◽

Typical Cell ◽

High Fluorescence ◽

Tomography Scan

Immune-related adverse events including cardiac toxicity are increasingly described in patients receiving immune checkpoint inhibitors. We described a malignant pericardial effusion complicated by a cardiac tamponade in an advanced non-small cell lung cancer patient who had received five infusions of atezolizumab, a PDL-1 monoclonal antibody, in combination with cabozantinib. The definitive diagnosis was quickly made by cytology examination showing typical cell abnormalities and high fluorescence cell information provided by the hematology analyzer. The administration of atezolizumab and cabozantinib was temporarily discontinued due to cardiogenic hepatic failure following cardiac tamponade. After the re-initiation of the treatment, pericardial effusion relapsed. In this patient, the analysis of the pericardial fluid led to the final diagnosis of pericardial tumor progression. This was afterwards confirmed by the finding of proliferating intrapericardial tissue by computed tomography scan and ultrasound. This report emphasizes the value of cytology analysis performed in a hematology laboratory as an accurate and immediate tool for malignancy detection in pericardial effusions.

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clinical correlates of pr-segment depression in asymptomatic patients with pericardial effusion

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(02)01889-2 ◽

2002 ◽

Vol 39 (12) ◽

pp. 2000-2004 ◽

Cited By ~ 19

Author(s):

Yoshihiro Kudo ◽

Fumiyasu Yamasaki ◽

Yoshinori Doi ◽

Tetsuro Sugiura

Keyword(s):

Pericardial Effusion ◽

Clinical Correlates ◽

Asymptomatic Patients

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CT-Guided Pericardiocentesis

Acta Radiologica ◽

10.1177/02841851960373p269 ◽

1996 ◽

Vol 37 (3P2) ◽

pp. 775-778 ◽

Cited By ~ 8

Author(s):

O. Duvernoy ◽

A. Magnusson

Keyword(s):

Cardiac Surgery ◽

Pericardial Effusion ◽

Guide Wire ◽

Pericardial Fluid ◽

Good Information ◽

Indwelling Catheter ◽

Ct Guided ◽

Cardiac Apex ◽

The Right ◽

Stereotactic Device

Purpose: Pericardial effusion in patients who have recently undergone cardiac surgery is often trapped in compartments. CT of the pericardium provides good information about the distribution of pericardial fluid in the postoperative period after cardiac surgery. Contrary to echocardiography, CT imaging is not affected by postoperative mediastinal emphysema and pain from the wound. A method for CT-guided pericardiocentesis was developed. Material and Methods: CT-guided pericardiocentesis was carried out with a stereotactic device in 10 patients. The pericardium was punctured with a 0.9-mm needle and a 0.46-mm guide wire was introduced through the needle. An indwelling catheter was introduced over the guide wire and was left in the pericardium. Both the subxiphoid and parasternal approaches were used. Results: CT guidance facilitated placement of an indwelling catheter into the pericardial space in positions difficult to reach in patients with postoperative pericardial compartments, i.e. near the right atrium and adjacent to the cardiac apex/left ventricle. Conclusion: CT-guided pericardiocentesis offers a new possibility in patients where fluoroscopically or echocardiographically guided pericardiocentesis is difficult.

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Age-related differences in antithrombotic therapy, success rate and in-hospital mortality in patients undergoing percutaneous coronary intervention

Clinical Research in Cardiology ◽

10.1007/s00392-011-0311-6 ◽

2011 ◽

Vol 100 (9) ◽

pp. 773-780 ◽

Cited By ~ 10

Author(s):

Arne Kristian Schwarz ◽

Ralf Zahn ◽

Matthias Hochadel ◽

Sebastian Kerber ◽

Karl E. Hauptmann ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Hospital Mortality ◽

Success Rate ◽

Antithrombotic Therapy ◽

Coronary Intervention ◽

Age Related ◽

Percutaneous Coronary ◽

Therapy Success

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Pericardial effusion in the course of fabry disease cardiomyopathy: A case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab407 ◽

2021 ◽

Author(s):

Toshihiro Tsuruda ◽

Yoshimasa Higashi ◽

Toshihiro Gi ◽

Shoichiro Nakao

Keyword(s):

Pericardial Effusion ◽

Fabry Disease ◽

Interleukin 6 ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

Japanese Woman ◽

Pericardial Fluid ◽

Interleukin 18 ◽

Previous Diagnosis ◽

Old Japanese

Abstract Background Fabry disease is an X chromosome-linked inherited disorder of glycosphingolipid metabolism due to deficient or absent lysosomal α-galactosidase A activity. Case summary A 51-year-old Japanese woman with a previous diagnosis of Fabry disease presented with pericardial effusion. The exudative pericardial fluid contained globotriaosylsphingosine. Left ventricular hypertrophy progressed despite regular administration of agalsidase alfa every 2 weeks over a 7-year period, with increases in plasma levels of globotriaosylsphingosine and interleukin-18. In addition, the interleukin-6 level in the pericardial fluid was markedly higher than that in plasma. Discussion This case suggests that elevated interleukin-6 and interleukin-18 levels in pericardial fluid and plasma indicate the severity of Fabry disease cardiomyopathy.

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Clinical Prognosis of Pericardial Effusion in COVID 19

10.21203/rs.3.rs-857221/v1 ◽

2021 ◽

Author(s):

İbrahim Saraç ◽

Gökhan Tonkaz ◽

Emrah Aksakal ◽

Faruk Aydınyılmaz ◽

Kaan Alişar ◽

...

Keyword(s):

Intensive Care ◽

Mortality Rate ◽

Pericardial Effusion ◽

Hospital Mortality ◽

Elevated Serum ◽

Clinical Prognosis ◽

Pneumonia Severity ◽

Polymerase Chain ◽

The Relationship

Abstract Purpose In our study, we investigated the relationship between pneumonia severity and pericardial effusion, predisposing factors and the effect of pericardial effusion on clinical prognosis and mortality in COVID-19 patients. Methods A total of 3794 patients who were diagnosed with COVID- 19 by polymerase chain reaction (PCR), were hospitalized between March 21 and November 30, 2020 were included in the study. For each of the 3794 patients, the initial chest CT images, pericardial efusion (PE), pleural efusion and pneumonia severity were evaluated. Results The mean age of patients with PE was higher and it was more common in males. Patients with PE had more comorbid diseases and significantly elevated serum cardiac and inflammatory biomarkers. In addition, the need for intensive care and mortality rates were higher in these patients. While the in-hospital mortality rate was 56.9% in patients with PE and AC involvement above 50%, in-hospital mortality rate was 34.4% in patients with AC involvement above 50% and without PE (p < 0.001). Conclusions In patients presenting with severe AC involvement on CT or being followed up with COVID-19 pneumonia, PE often accompanies the deterioration in the laboratories and clinics of the patients. The clinical prognosis in patients presenting with PE was quite poor, and the frequency of intensive care admissions and mortality were significantly higher. In conclusion, in our study, PE emerged as an important finding in the follow-up and management of patients with COVID-19 and reflects the clinical prognosis.

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Hospital mortality in hematogenous vertebral osteomyelitis

Hirurgiâ pozvonočnika ◽

10.14531/ss2021.3.86-93 ◽

2021 ◽

Vol 18 (3) ◽

pp. 86-93

Author(s):

A. Yu. Bazarov ◽

K. S. Sergeyev ◽

A. O. Faryon ◽

R. V. Paskov ◽

I. A. Lebedev

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Hospital Mortality ◽

Medical Records ◽

Vertebral Osteomyelitis ◽

Hospital Death ◽

Factors Affecting ◽

Comorbidity Index ◽

Probability Of Death ◽

Type C

Objective. To analyze lethal outcomes in patients with hematogenous vertebral osteomyelitis.Material and Methods. Study design: retrospective analysis of medical records. A total of 209 medical records of inpatients who underwent treatment for hematogenous vertebral osteomyelitis in 2006–2017 were analyzed. Out of them 68 patients (32.5 %) were treated conservatively, and 141 (67.5 %) – surgically. The risk factors for lethal outcomes were studied for various methods of treatment, and a statistical analysis was performed.Results. Hospital mortality (n = 9) was 4.3 %. In patients who died in hospital, average time for diagnosis making was 4 times less (p = 0.092). The main factors affecting mortality were diabetes mellitus (p = 0.033), type C lesion according to the Pola classification (p = 0.014) and age over 70 years (p = 0.006). To assess the relationship between hospital mortality and the revealed differences between the groups, a regression analysis was performed, which showed that factors associated with mortality were Pola type C.4 lesions (OR 9.73; 95 % CI 1.75–54.20), diabetes mellitus (OR 5.86; 95 % CI 1.14–30.15) and age over 70 years (OR 12.58; 95 % CI 2.50–63.34). The combination of these factors increased the likelihood of hospital mortality (p = 0.001). Sensitivity (77.8 %) and specificity (84.2 %) were calculated using the ROC curve. In the group with mortality, the comorbidity index (CCI) was significantly higher (≥4) than in the group without mortality (p = 0.002). With a CCI of 4 or more, the probability of hospital death increases significantly (OR 10.23; 95 % CI 2.06–50.82), p = 0.005. Long-term mortality was 4.3 % (n = 9), in 77.8 % of cases the cause was acute cardiovascular pathology, and no recurrence of vertebral osteomyelitis was detected.Conclusion. Hospital mortality was 4.3 %, and there was no mortality among patients treated conservatively. The main risk factors were diabetes mellitus, type C lesion according to Pola and age over 70 years. There was a significant mutual burdening of these factors (p = 0.001). With CCI ≥4, the probability of death is higher (p = 0.005).

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