Abstract 13871: Tamponade Physiology: To Tap or Not to Tap?

Abstract

Introduction: Cardiac tamponade is often evaluated through echocardiography. However, not all patients with tamponade physiology develop clinical tamponade. Thus, we evaluated various echocardiographic and clinical factors as predictors of the need for intervention. Methods: A total of 264 patients with tamponade physiology were extracted from the echocardiographic database. We compared clinical and demographic factors among those who underwent intervention vs. conservative care. Factors with p value of <0.2 were included in a multivariable logistic regression model. Results: 76% of these patients had moderate to large pericardial effusions, and their mean MAP was 92 mmHg. Half of these patients (n=134) had either pericardiocentesis or a pericardial window. Only 7 patients (3%) required a repeat pericardiocentesis.Intervention patients had more positive echocardiographic parameters (2 (1-3) vs 1.5 (1-2) p<0.001) and moderate to large pericardial effusions (90% vs 62% p<0.001). On multivariable logistic regression, uremic or CKD-related effusion was independently associated with less interventions OR 0.22; 95% CI (0.07-0.67) p=0.007 while systolic RA collapse, diastolic RV collapse, IVC plethora and tricuspid inflow variation were all independently associated with higher odds of pericardial intervention AUC of overall model 0.81, 95 percent CI [0.76-0.86]. Conclusions: In this sample of patients with tamponade physiology on echocardiography, a model using a combination of echo and demographic parameters demonstrated good but not perfect discrimination in predicting the need for intervention. Clinical judgment remains important.