Cardiac tamponade in a multiracial population- epidemiology, clinical characteristics and survival outcomes - a single centre experience

Abstract

Funding Acknowledgements Type of funding sources: None. Background Cardiac tamponade is a medical emergency which requires prompt medical intervention via pericardiocentesis. Diverse etiologies has been attributed, with malignancy and Tuberculous effusions being the leading causes. The aim of this study is to compare clinical characteristics and survival outcome in a multiethnic Asian centre. Methods We performed a single centre retrospective analysis in a hospital in Malaysia. All patients who are acutely presenting with echocardiographic cardiac tamponade between January 2013 to July 2022 were included in this study. Demographic details, clinical presentations, echographic findings, fluid analysis procedural details, and complications were obtained via electronic medical records. Data were analysed using Statistical Package for the Social Sciences version 26 Software. Results Of the 6015 patients admitted to our CCU over 9 years, we identified 46 patients fulfilling criteria of tamponade, representing about 0.8% of total admission. Mean age of our cases are 44.59 (±16.48).Males represent 60.9%( n=28) of our cases with Malay race forming nearly 54.3% ( n=25), followed by Chinese, 28.3% ( n= 13). Orthopnea was the commonest clinical manifestation representing 89.1%,followed by tachypnoea ( 69.6% ),fever (69.6%, cough ( 63%,) , and pleuritic chest pain (26.1%.) Malignancy forms the bulk of our cases (60.9%, n= 28), with lung malignancy being the commonest ( 42%, n= 12), followed by breast ( 25%, n= 7), and lymphoma (17.9%, n= 5). Other aetiologies includes infective cause (15.2% , n= 7), with Tuberculosis being the predominant cause, Uremic effusion (10.86 %, n= 5) and rheumatological effusion ( 6.5%, n= 3). Complications occurred in 34.8 % ( n=16) of our cases, with mortality reaching up to 43.8% ( n=7). No significant association seen between Race, tamponade size, amount drained and drainage duration among the oncology vs non oncologic groups ( P value >0.005). The median survival time is 28 days (SE=1.23) for oncology patients and 52 days (0.0) for non-oncology patients at 1 year. Log-rank test indicated that survival experience is significantly different (p< 0.048) between groups in one year outcome. Lymphoma patients have better median survival rate than breast cancer patients (P=0.014) Conclusion Malignancy is the commonest cause of Cardiac Tamponade at our centre. Lymphoma patients with tamponade fare better compared to other forms of malignancy, with breast cancer patient faring the worst.