Cardiac Tamponade in Medical Patients: A 10-Year Follow-Up Survey

Abstract

Objectives: Cardiac tamponade represents a life-threatening condition that may complicate almost any cause of pericarditis. We conducted a 10-year prospective survey on patients with cardiac tamponade requiring an emergency drainage. Methods: From 1996 to 2005, 114 consecutive patients were admitted to the University Hospital of Brest for medical cardiac tamponade. Data on medical history, and volume, characteristics and histology of the pericardial fluid as well as short- and long-term follow-up data were collected. Results: Malignant disease was the primary cause of medical tamponade (74 patients; 65%), followed by viral history (11; 10%) and intra-pericardial bleeding due to anti-coagulation treatment (4; 3%). In 12 cases, aetiology remained unknown (10%). Pericardiocentesis was immediately performed in 80 cases and surgical pericardiotomy in 34. The mean volume drained was 593 ± 313 ml. In-hospital mortality was 10% without any difference between malignant and non-malignant diseases (p = 0.8). One-year mortality was 76.5% in patients with malignant disease and 13.3% in those without malignant disease (p < 0.0001). Median survival in case of malignant disease was 150 days. Conclusion: Compared to previously published data, our survey shows a decrease in some historical causes of tamponade such as tuberculosis, myxoedema or uraemia. The leading cause is currently malignant disease, which carries a very poor prognosis.

Contemporary evaluation of the causes of cardiac tamponade: Acute and long-term outcomes

“…This finding contrasts with previous clinical studies, which reported malignant diseases as the most common cause of pericardial tamponade, reaching 30-60% of cases [6][7][8][9][10][11]. This shift in tamponade etiology is apparently due to the increase in recent years in the overall number and in the complexity of percutaneous intra-cardiac procedures, as well as the introduction of interventional techniques such as trans-catheter valve replacement and catheter ablation for atrial fibrillation, all reported to be possibly complicated by cardiac tamponade [12][13][14][15].…”

Preliminary Investigation of the Clinical Value of Vascular Endothelial Growth Factor and Hypoxia-Inducible Factor-1α in Pericardial Fluid in Diagnosing Malignant and Tuberculous Pericardial Effusion

“…Transudative pericardial effusions mainly occur in patients with heart, kidney or liver disease or hypothyroidism and are easy to diagnose. It is important to treat the primary disease, and it is usually not necessary to perform pericardiocentesis [1,2,3,4,5,6]. Exudative pericardial effusions can be divided into malignant and nonmalignant types.…”

“…Pericardial effusion is a common cardiovascular disease and can be caused by many conditions [1,2,3,4,5,6]. The therapy and prognosis of pericardial effusion mainly depend on the etiology.…”

Cardiovascular Oncologic Emergencies

“…A prospective observational study that included all patients with PT showed malignancies as the most common cause with 32% of all cases for PT [9]. A 10-year prospective study of 114 patients with PT demonstrated malignant disease in 74 patients (65%) [10]. In autopsy series, the pericardium was involved in about two-thirds of patients with cancers.…”

“…Patients with malignant pericardial effusions in lung cancer have an overall worse prognosis than individuals with breast or hematological malignancies. A 10-year survey of patients with PT showed that patients with malignant pericardial effusion carried a high in-hospital mortality with a median survival of 150 days and a 1-year mortality of almost 77% [10]. Considering recurrence is a major issue in malignant pericardial effusion, balloon pericardiotomy or surgical drainage is effective in symptomatic management.…”