Prognostic implications of pericardial effusion: The importance of underlying etiology

Santas, Enrique; Núñez, Julio

doi:10.1016/j.ijcard.2015.09.051

Cited by 4 publications

(4 citation statements)

References 7 publications

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“…Specifically, the PE recurrence rate was only 15% in the first year after the index PCC and increased to only 16% after 5 years. This rate is lower than that reported previously ( 13 ). The low recurrence rate in our study can be explained by the close monitoring of the pericardial drain output, the standardized approach used for drain removal (based on 24-h drain output), and the encouraged use of echocardiography prior to drain removal.…”

Section: Discussioncontrasting

confidence: 73%

Predictors of Recurrence and Survival in Cancer Patients With Pericardial Effusion Requiring Pericardiocentesis

Ahmed

Mouhayar

Song

et al. 2022

Front. Cardiovasc. Med.

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AimThis study investigated the factors predicting survival and the recurrence of pericardial effusion (PE) requiring pericardiocentesis (PCC) in patients with cancer.Materials and MethodsWe analyzed the data of patients who underwent PCC for large PEs from 2010 to 2020 at The University of Texas MD Anderson Cancer Center. The time to the first recurrent PE requiring PCC was the interval from the index PCC with pericardial drain placement to first recurrent PE requiring drainage (either repeated PCC or a pericardial window). Univariate and multivariate Fine-Gray models accounting for the competing risk of death were used to identify predictors of recurrent PE requiring drainage. Cox regression models were used to identify predictors of death.ResultsThe study cohort included 418 patients with index PCC and pericardial drain placement, of whom 65 (16%) had recurrent PEs requiring drainage. The cumulative incidences of recurrent PE requiring drainage at 12 and 60 months were 15.0% and 15.6%, respectively. Younger age, anti-inflammatory medication use, and solid tumors were associated with an increased risk of recurrence of PE requiring drainage, and that echocardiographic evidence of tamponade at presentation and receipt of immunotherapy were associated with a decreased risk of recurrence. Factors predicting poor survival included older age, malignant effusion on cytology, non-use of anti-inflammatory agents, non-lymphoma cancers and primary lung cancer.ConclusionAmong cancer patients with large PEs requiring drainage, young patients with solid tumors were more likely to experience recurrence, while elderly patients and those with lung cancer, malignant PE cytology, and non-use of anti-inflammatory agents showed worse survival.

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Section: Discussioncontrasting

confidence: 73%

Predictors of Recurrence and Survival in Cancer Patients With Pericardial Effusion Requiring Pericardiocentesis

Ahmed

Mouhayar

Song

et al. 2022

Front. Cardiovasc. Med.

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“…3 Data on the frequency of different etiologies and, more specifically, on primary or metastasized malignancies remain scarce and vary widely among the few studied populations. [4][5][6][7][8][9][10] In the past 2 decades, only 5 sizeable prospective series on the etiology of pericardial effusions have been reported. Two of those series included distinct populations in which tuberculosis and human immunodeficiency virus (HIV) are common, and thus the participants are not necessarily representative of other cohorts.…”

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confidence: 99%

Etiology and Long‐Term Outcome of Patients Undergoing Pericardiocentesis

Strobbe

Adriaenssens

Bennett

et al. 2017

JAHA

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BackgroundPericardial effusions can be caused by a variety of disorders. The frequency of the underlying diseases varies with patient population; therefore, previously reported series are not necessarily representative of other populations. Our purpose was to examine the etiology of pericardial effusions and the survival of patients requiring pericardiocentesis at a tertiary center.Methods and ResultsWe performed a retrospective observational study of 269 consecutive patients who underwent percutaneous pericardiocentesis at our university hospital between 2006 and 2016 and had prospective follow‐up for up to 10 years. The most frequent etiologies were idiopathic (26%), malignancy (25%), and iatrogenicity (20%), whereas bacterial causes were very rare. The most frequent malignancies originated from the lung (53%) or breast (18%). A new cancer was diagnosed with malignant pericardial effusion as the presenting complaint for 9% of patients, whereas the pericardium was the first metastatic site of a known malignancy in 4% of patients. Survival was significantly poorer in malignancy‐related versus non–malignancy‐related effusions (P<0.001) and in cytology‐positive versus cytology‐negative effusions in the overall cohort (P<0.001). Among cancer‐only patients, however, there was no significant difference in long‐term survival between cytology‐positive and ‐negative effusions.ConclusionsIn this contemporary tertiary‐center cohort, pericardial effusions often represent the primary instance of a new malignancy, underscoring the importance of cytological analyses of noniatrogenic effusions in patients without known cancer, as survival is significantly worse. In cancer patients, however, the presence of pericardial malignant cytology does not appear to affect outcome significantly.

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“…However, it is noteworthy, that pericardial effusion is not an entirely distinct disease, and the key point is to define the underlying etiology [3]. In this letter, the authors stated that "Pericardial effusion is well known to make changes in the electrocardiogram.…”

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confidence: 99%

“…The main challenge is to establish the potential etiology. Sometimes, the pericardial effusion can be easily related to a known underlying disease, such as acute myocardial infarction, cardiac surgery, end-stage renal disease, or widespread metastatic neoplasm [3]. Therefore, electrocardiographic changes and myocardial repolarization abnormalities as well as structural alterations should be evaluated in the context of underlying disease.…”

mentioning

confidence: 99%