Diagnostic value of transthoracic echocardiography and computerized tomography for surgically confirmed late tamponade after cardiac surgery

Abstract

Background: Late tamponade after cardiac surgery is a clinically obscure condition presenting significant diagnostic challenges, since it may be difficult to detect using routine imaging studies. This study is aimed to investigate the diagnostic value of transthoracic echocardiography (TTE) and contrast-enhanced computerized tomography (cCT) in the diagnosis of late tamponade following open-heart surgery.Methods: A total of 88 patients who underwent reoperation after cardiac surgery with suspected late cardiac tamponade were included in this retrospective study.All the patients had TTE and cCT examinations before reoperation. The diagnostic values of these imaging modalities were investigated using surgically confirmed late tamponade as the standard.Results: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of an optimal cutoff value of greater than 3.1 cm pericardial fluid thickness on cCT images for predicting surgically confirmed late tamponade were 91.4%, 66.6%, 97.4%, 36.3%, and 89.7%, respectively. Accordingly, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of TTE for the diagnosis of late tamponade were 34.1%, 50.0%, 90.3%, 5.2%, and 35.2%, respectively. The cCT provided false-negative results in seven patients (8%), while this figure was 54 (61.4%) for that of TTE.Conclusion: Computerized tomography imaging seems to represent a superior imaging technique in terms of visualizing the intrapericardial fluid collections after cardiac surgery and has the potential to readily diagnose late tamponade and effectively prevent unnecessary morbidity and mortality. K E Y W O R D S cardiac surgery, computerized tomography, late tamponade, transthoracic echocardiography

Diagnostic performance of echocardiography to predict cardiac tamponade after cardiac surgery

“…The incidence of cardiac tamponade after cardiothoracic surgery ranges from 0.5% to 8.8% [ 1 , 3 ]. Although there is no clear consensus, literature differentiates between early (<72 h) and late (>72 h) tamponade depending on the timing after surgery [ 3 , 8 ]. Early diagnosis and re-exploration are important to prevent further deterioration, serious complications and death [ 2 , 8 ].…”

“…Although there is no clear consensus, literature differentiates between early (<72 h) and late (>72 h) tamponade depending on the timing after surgery [ 3 , 8 ]. Early diagnosis and re-exploration are important to prevent further deterioration, serious complications and death [ 2 , 8 ]. However, re-explorations also increase the risk of acute-kidney injury, atrial fibrillation, sternal wound infections, pulmonary infections, increased number of days on mechanical ventilation and an increased ICU length of stay [ 2 , 9 ].…”

“…TEE may overcome these practical drawbacks of TTE. However, evidence on the diagnostic accuracy of TTE and TEE remains scarce in this postoperative setting with broad ranges of sensitivity (34–93% for TTE) and specificity (30–90% for TTE) [ 1 , 3 , 5 , 8 , 10 , 11 , 15–19 ]. These broad ranges hamper the involved multidisciplinary team of surgeons, cardiologists and anaesthesiologists or intensivists to determine the value of the TTE or TEE within their decision-making process in patients with a suspected tamponade after cardiac surgery.…”

Transthoracic echocardiography and computerized tomography for surgically confirmed late tamponade after cardiac surgery: Methodological issues on diagnostic value and prediction

“…lowing open-heart surgery. 1 Eighty-eight patients with late tamponade diagnosis were retrospectively evaluated. The diagnostic value was evaluated by sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).…”

“…The authors reported that the sensitivity, specificity, PPV, NPV, and accuracy of an optimal cutoff value on cCT images for predicting late tamponade and on TTE for the diagnosis of late tamponade were (91.4%, 66.6%, 97.4%, 36.3%, and 89.7%) and (34.1%, 50.0%, 90.3%, 5.2%, and 35.2%), respectively. 1 It is good to know that diagnostic value should be considered as a combination of diagnostic accuracy (validity) and diagnostic precision (reliability) which conceptually and methodologically are two different issues. To assess validity for qualitative variables, sensitivity, specificity, PPV, NPV, positive likelihood ratio (LR+) and negative likelihood ratio (LR−) as well as diagnostic accuracy and odds ratio (ratio of true to false results) are among the most appropriate estimates.…”