Abstract
BackgroundEchocardiographic signs of constrictive physiology (CP) after pericardiocentesis are frequently observed in malignancy patients. The purpose of the current study was to explore whether features of CP after pericardiocentesis have prognostic impact in malignancy patients with pericardial effusion (PE).MethodsWe retrospectively reviewed 467 consecutive patients who underwent pericardiocentesis at our institution from January 2006 to May 2014. Among them, 205 patients with advanced malignancy who underwent comprehensive echocardiography after the procedure comprised the study population. Co-primary end points were all-cause mortality (ACM) and repeated drainage (RD) for PE. Patients were divided into four subgroups according to cytologic result for malignant cells and CP (positive cytology with negative CP, both positive, both negative, and negative cytology with positive CP).ResultsCP after pericardiocentesis was present in 106 patients (50%) at median 4 days after the procedure. During median follow-up of 208 days, ACM and RD occurred in 162 patients (79%) and 29 patients (14%), respectively. Cox regression analysis revealed that independent predictors for ACM were male gender and positive cytology (all, p < 0.05). For RD, predictors were positive cytology, the absence of cardiac tamponade, and negative CP after pericardiocentesis (all, p < 0.05). When the patients were divided into four subgroups, patients with negative cytology and positive CP demonstrated the most favorable survival (hazard ratio [HR]: 0.39, p = 0.005) and the lowest RD rates (HR: 0.07, p = 0.012).ConclusionCP after pericardiocentesis is common, but does not always imply poor survival or the need for RD in patients with advanced malignancies. On the contrary, the presence of CP in patients with negative cytology conferred the most favorable survival and the lowest rate of RD. Comprehensive echocardiographic evaluation for CP after pericardiocentesis would be helpful for predicting prognosis in patients with advanced malignancies.
Highlights
Cardiac tamponade is an acute or subacute compression of the heart due to pericardial fluid accumulation and can be life-threatening
Constrictive physiology (CP) after pericardiocentesis was present in 106 patients (50%) at median 4 days after the procedure
When the patients were divided into four subgroups, patients with negative cytology and positive CP demonstrated the most favorable survival and the lowest repeated drainage (RD) rates (HR: 0.07, p = 0.012)
Summary
Cardiac tamponade is an acute or subacute compression of the heart due to pericardial fluid accumulation and can be life-threatening. The most common cause of cardiac tamponade is malignancy, which is involved in > 50% of all tamponade cases[1]. Pericardiocentesis is lifesaving in cases of cardiac tamponade; it alone frequently results in the resolution of large pericardial effusion (PE) in malignancy patients, but recurrence is common[2,3,4,5,6,7]. Echocardiographic CP is found in patients with symptomatic constrictive pericarditis, but is more commonly observed in rather benign conditions, especially in post-cardiac surgery patients without clinical constrictive pericarditis when assessed with comprehensive examination[9]. Postoperative CP after cardiac surgery has been reported to be relatively common and is usually transient and benign[9]. Echocardiographic signs of constrictive physiology (CP) after pericardiocentesis are frequently observed in malignancy patients. The purpose of the current study was to explore whether features of CP after pericardiocentesis have prognostic impact in malignancy patients with pericardial effusion (PE)
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