Outcomes Of Pericardial Effusion Research Articles

Etiologic Pattern, Severity, and Outcome of Pericardial Effusion Among Children Seen Over Ten Years at a Tertiary Hospital in Sokoto, Northwest Nigeria

Etiologic Pattern, Severity, and Outcome of Pericardial Effusion Among Children Seen Over Ten Years at a Tertiary Hospital in Sokoto, Northwest Nigeria

Risk factors and outcomes of pericardial effusion in cancer patients receiving PD-1 inhibitors

BackgroundProgrammed cell death 1 (PD-1) inhibitors can induce various adverse reactions associated with immunity, of which cardiotoxicity is a serious complication. Limited research exists on the link between PD-1 inhibitor use and pericardial effusion (PE) occurrence and outcomes. MethodsWe conducted a retrospective study at the First Affiliated Hospital of Xi'an Jiaotong University from 2017 to 2019, comparing cancer patients who developed PE within 2 years after PD-1 inhibitor therapy to those who did not. Our primary outcome was the all-cause mortality rate at one year. We applied the Kaplan-Meier method for survival analysis. Multivariate logistic regression was utilized to identify PE risk factors, adjusting for potential confounders. ResultsA total of 91 patients were finally included, of whom 39 patients had PE. Compared to non-PE group, one-year all-cause mortality was nearly 5 times higher in PE group (64.10% vs. 13.46%, P < 0.001). Patients who developed PE within 2 years of taking PD-1 inhibitors were significantly associated with increased all-cause mortality compared with those who did not (HR: 6.26, 95%CI: 2.70–14.53, P < 0.001). Multivariable logistic regression showed that use of sintilimab (OR: 14.568, 95%CI: 3.431–61.857, P < 0.001), history of lung cancer (OR: 15.360, 95%CI: 3.276–72.017, P = 0.001), and history of hypocalcemia (OR: 7.076, 95%CI: 1.879–26.649, P = 0.004) were independent risk factors of PE development in patients received PD-1 inhibitors therapy. ConclusionsIn cancer patients receiving PD-1 inhibitors, PE was associated with higher one-year mortality. Use of sintilimab, and history of lung cancer or hypocalcemia were linked to PE occurrence.

259 PERICARDITIS AND PERICARDIAL EFFUSION IN CHRONIC GRAFT-VERSUS-HOST DISEASE AFTER ALLOGENIC HEMATOPOIETIC STEM CELL TRANSPLANTATION

Abstract Background Pericarditis and pericardial effusion (PE) are rare but potentially life-threatening complications in chronic graft-vs-host disease (cGVHD). Limited data are currently available in this setting, based on small single-center retrospective studies. The purpose of this study is to characterize the clinical presentation, management, and outcomes of pericarditis and PE complicating cGVHD in allogeneic hematopoietic cell transplant recipients. Material and Methods We included all consecutive patients referred to our pericardial diseases referral center from 1st May 2008 to 1st May 2022. All patients had no previous cardiovascular or autoimmune diseases and suffered from severe cGVHD with involvement of at least 2 organs. Pericarditis and PE were diagnosed according to ESC guidelines. Conditioning-related toxicity and infections were carefully excluded. Results Pericarditis was diagnosed in 4 patients (2 males, mean age 48.5 ±9.0 years), of whom 2 developed mild PE. PE without pericarditis was diagnosed in 5 patients (80% male, aged 53.2 ±8.9 years), in 2 patients it was reported as severe, requiring pericardial drainage. The average time after allogeneic hematopoietic stem cell transplantation was 22 months (range, 4 to 58 months). All patients required escalation of the corticosteroid therapy they were chronically taking, and in 4 cases the therapy was boosted with non-steroidal anti-inflammatory drugs. Only one patient developed a recurrence and died of multiorgan failure associated with severe cGVHD (involving eyes, mucous membranes, skin, joints, liver, pleuro-pericardial effusion) refractory to immunosuppressive therapy. Overall survival was 89% and no patient developed constrictive pericarditis. Mean follow-up was 69±55 months. Conclusions Pericarditis and PE related to cGVHD typically occur with mild clinical signs in the context of severe cGVHD, however in our study 22% of patients required pericardial drainage at diagnosis. The mainstay of treatment is high-dose steroids and usually the majority of patients have a favorable outcome.

1594P Outcome, mortality and 30-day readmission of pericardial effusion in cancer patients

A pericardial effusion (PE) with various inflammatory and non-inflammatory causes can range from an incidental finding to a life-threatening emergency such as a cardiac tamponade. In the literature, little is known about the outcomes of PE in cancer patients. The study's primary objective was to assess whether intervention in PE affects in-hospital mortality and 30-days readmission among cancer patients. A retrospective study of a nationally representative cohort of hospital admissions was conducted from January 1, 2016, to December 31, 2019. Data was collected from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project Nationwide Readmissions Database. All adult patients ≥18 years admitted with primary diagnosis of pericardial effusion in cancer patients were included in the study. We used the International Classification of Diseases, 10th revision, diagnostic codes to identify variable. The type of cancer included in the study were Breast, Lung, pancreatic, bladder, renal, colorectal, lymphoma and acute leukemia. The patients were stratified as PE in cancer patients underwent intervention versus no intervention. A total of 37,430 index hospitalizations for PE in cancer patients were identified for the years 2016-2019 in the NRD with the 27,980 index hospitalizations for PE without intervention, and 9,450 index hospitalizations for PE with intervention. There was no difference in in-hospital mortality for PE with and without intervention (4.5% vs 4.4%; p 0.76). However, PE without intervention had a significantly higher 30-day readmission rate than PE with intervention (31% vs 4.2.0%; p <0.001). The PE with intervention group had higher multi-organ complications including cardiogenic shock (8.6% vs 5.5%; p-value <0.001), Acute Kidney Injury (AKI) (29% vs 24.0%; p-value <0.001), respiratory failure (25% vs 20%, p-value <0.001), pneumonia (15% vs 12.6%, p-value 0.004), atrial fibrillation (27% vs 23.8%, p-value<0.001). Survival rates were not different between patients who received intervention and those who did not, but 30-day readmission rates were significantly higher for patients who did not receive intervention. Cancer patients would benefit from PE intervention.

Periprocedural Pericardial Effusion Complicating Transcatheter Left Atrial Appendage Occlusion: A Report From the NCDR LAAO Registry.

Pericardial effusion (PE) is a potential complication of transcatheter left atrial appendage occlusion. The objective of this study was to investigate the incidence, associated characteristics, and outcomes of PE following left atrial appendage occlusion. Patients in the NCDR LAAO Registry who underwent a Watchman procedure between January 1, 2016 and December 31, 2019 were included. The primary outcome was in-hospital PE requiring intervention (percutaneous drainage or surgery). Odds ratios (ORs) were calculated for adverse event rates associated with PE. The study population consisted of 65 355 patients. The mean patient age was 76.2±8.1 years, and the mean CHA2DS2-VASc score was 4.6±1.5. PE occurred in 881 patients (1.35%). Clinical variables independently associated with PE included older age, female sex, left ventricular function, paroxysmal atrial fibrillation, prior bleeding, lower serum albumin, and preprocedural dual antiplatelet therapy; procedural variables included number of delivery sheaths used, sinus rhythm during the procedure, and moderate sedation rather than general anesthesia. PE was associated with increased risk of in-hospital stroke (OR, 6.58 [95% CI, 3.32-13.06]; P<0.0001), death (OR, 56.88 [95% CI, 39.79-81.32]; P<0.0001), and the composite of death, stroke, or systemic embolism (OR, 28.64 [95% CI, 21.24-38.61]; P<0.0001). PE during the index hospitalization was associated with increased risk of death (OR, 3.52 [95% CI, 2.23-5.54]; P<0.0001) and the composite of death, stroke, or systemic embolism (OR, 3.42 [95% CI, 2.31-5.07]; P<0.0001) between discharge and 45-day follow-up. In-hospital PE during transcatheter left atrial appendage occlusion is infrequent but associated with a substantially higher risk of adverse events, including in-hospital and early postdischarge mortality. Strategies to minimize PE are critical to improve the risk-benefit ratio for this therapy.

B-PO02-117 PERICARDIAL EFFUSIONS DURING LEFT ATRIAL ABLATION PROCEDURES IN PATIENTS RECEIVING NON-WARFARIN ORAL ANTICOAGULANTS: MANAGEMENT AND OUTCOMES

An increasing number of left atrial ablation procedures are being performed on patients receiving non-warfarin oral anticoagulants (NOACs), often uninterrupted. Little has been reported on the management and outcomes of pericardial effusion in the setting of NOAC use. To evaluate the characteristics and outcomes of procedure-related pericardial effusion while taking NOACs. We performed a single-center retrospective review of all left atrial catheter ablation procedures between 2017 and 2020. Data collection included patient demographics, procedure type, pre-procedural anticoagulation strategies, peri-procedural management, and outcomes. Of the 2192 ablation procedures performed, 22 pericardial effusions occurred (1.0%), of which 21 occurred in patients taking NOACs (Apixaban in 15, Rivaroxaban in 6) - uninterrupted in 15 (71.4%; see Table). Pericardiocentesis was performed in 20 of 21 patients (95.2%), either intraoperatively (n=16) or for delayed effusion (n=5); repeat pericardiocentesis was required in 3 patients (14.3%). Reversal agents were frequently used: protamine (n=12) and prothrombin concentrate complex (n=7). Additional management strategies included covered stent implant for CS perforation (n=2) and Amplatzer plug implant for LA wall perforation (n=1). Surgery was not required, and there were 0 strokes and deaths. Median length of hospital stay was 3 days (range 1-12). Left atrial ablation procedure-related pericardial effusion on NOACs can be managed without surgical intervention. Novel NOAC-specific reversal agents may further streamline management.

Prevalence and Outcomes of Pericardial Effusion in Kidney Transplant Candidates

Pericardial disease is a recognized manifestation of cardiovascular disease in the end-stage renal disease (ESRD) population, and can manifest as pericardial effusion, though the prognosis of pericardial disease in ESRD patients is unclear. In the modern era of renal replacement therapy, little is known about the prevalence and the implications of pericardial effusion in ESRD patients, its echocardiographic characteristics, and risk factors. We conducted a retrospective chart review on subjects > than 18 years of age with known ESRD who were undergoing outpatient evaluation for renal transplantation at Mayo Clinic Arizona between January 2001 and December 2015 and had baseline echocardiogram completed within 3 months of their initial evaluation. Patients with moderate sized pericardial effusions or larger were identified. The pericardial effusion cohort was age and gender matched with a cohort of patients with ESRD without pericardial effusion in a 1:2 fashion. 54 patients with moderate or greater sized pericardial effusion out of 2,820 patients that fit our inclusion criteria, corresponding to a prevalence of 1.9%. A total of 41 patients or 75.9%, had a moderate sized effusion. A total of 13 patients, or 24.1% had a large sized effusion, 7 of whom had tamponade physiology on echocardiography. The presence and size of the effusion was not predictive for worse outcomes. Hemodialysis duration was protective, but no other factors were predictive or protective in the development of moderate sized or larger pericardial effusions, including echocardiographic parameters.

Incidence and Outcome of Pericardial Effusion in Pediatric Patients After Hematopoietic Stem Cell Transplant: A Single-institution Experience.

Pericardial effusion (PE) is a known complication after hematopoietic stem cell transplant (HSCT). Limited data is currently available regarding the incidence and outcomes of PE in pediatric HSCT. We conducted a retrospective study on a cohort of patients who underwent HSCT between 2004 and 2015. Risk factors associated with development of PE were evaluated. In 111 HSCT, stem cell source was bone marrow in 37 (33.3%), peripheral blood-42 (37.8%) and cord blood-32 (28.8%). Incidence of PE after HSCT was 37.8%. Insignificant effusion (trivial or small) was noted in 30 (27.0%) transplants, and significant (moderate or large) PE in 12 (10.8%). There were no associations between incidence of effusion and stem cell source, graft versus host disease or CMV infection. Risk factors associated with development of PE included systemic hypertension (P<0.05), total body irradiation (P<0.05), and sinusoidal obstruction syndrome formerly known as venoocclusive disease (P=0.03). Overall mortality was 22.5% after HSCT, but 38.1% among those with effusion (P<0.05). None of these deaths were attributed to primary cardiac etiologies. The incidence of PE in this cohort of pediatric HSCT recipients is high and associated with higher morbidity and mortality.

Predictors and Outcome of Pericardial Effusion After Hematopoietic Stem Cell Transplantation in Children

Pericardial Effusion (PE) is a potentially life-threatening complication of Hematopoietic Cell Transplantation (HCT). Our study aim was to identify incidence, risk factors, response to treatment, and outcome of PE after pediatric HCT. All patients after HCT at our tertiary center between 2005 and 2010 were included. Endpoints were PE development and overall survival. We analyzed patient factors, HCT details, and complications and used Cox proportional hazard regression modeling to identify predictors for PE. Twelve out of 129 patients (9.3%) developed PE. Multivariate analysis demonstrated that young age at HCT was a predictor for PE: expressed per year increase in age HR = 0.66 (95% CI 0.46–0.95, p = 0.03). PE had no impact on overall mortality of HCT. Mild respiratory symptoms and vomiting were presenting symptoms for PE. Discontinuation of calcineurin inhibitors—with or without pericardiocentesis—was the only effective treatment for PE, in contrast to diuretics or increased immunosuppression. Seven of 12 PE patients had pericardiocentesis, which was safe and effective in all. Pericardial effusion is not rare after HCT, and young age is the only significant risk factor. Calcineurin inhibitor toxicity appears to be the primary cause of PE after HCT, and discontinuation is effective in the reduction of PE. Pericardiocentesis for PE is a safe and effective procedure. Pericardial effusion did not have an impact on survival after HCT.

INCIDENCE AND OUTCOME OF PERICARDIAL EFFUSION IN PEDIATRIC PATIENTS UNDERGOING STEM CELL TRANSPLANT

Pericardial effusion (PE) is a known complication after stem cell transplant (SCT) with echocardiography being used as the primary screening tool for diagnosis. Limited data is currently available regarding the incidence and outcomes of PE in pediatric SCT. We conducted a retrospective review of a

Pericardial effusion in atrial fibrillation ablation: a comparison between cryoballoon and radiofrequency pulmonary vein isolation

Atrial fibrillation (AF) ablation is increasingly being performed in electrophysiology laboratories. Pericardial effusion (PE) is certainly one of the most frequently observed complications during AF ablation. The aim of our study was to investigate the incidence and outcome of PE following cryothermal energy balloon ablation (CBA) in comparison with conventional circumferential pulmonary vein isolation with a focal radiofrequency (RF) catheter. A total of 133 consecutive patients (105 males) with paroxysmal AF were included in this study. Forty-six patients (36 males) underwent CBA (Arctic Front, Medtronic, USA) and 87 (69 males) point-by-point RF ablation guided by electroanatomical mapping (Carto, Biosense Webster, Diamond Bar, CA, USA). Ablation was performed under general anaesthesia with both techniques. All patients underwent a 2D transthoracic echocardiogram within 24 h before and after the procedure as routinely performed in our centre. Pericardial effusion was detected in 19 (14.2%) of 133 patients. Sixteen patients presented mild effusion, one moderate effusion, and two pericardial tamponades. There was no significant difference in the incidence of PE between the cryoballoon and the RF group (11 vs. 16%). A longer procedural time, coronary artery disease, and arterial hypertension were found to be independent predictors of PE during AF ablation. Pericardial effusion occurred in a similar proportion following CBA and RF ablation for AF. Pericardial effusion was mostly mild and asymptomatic, with benign clinical outcome not requiring additional hospitalization days.