Pericardial Effusion In Patients Research Articles

Changes in Cardiac Structure and Function of Recipients after Kidney Transplantation.

Background: Chronic kidney disease (CKD) elevates the risk of cardiovascular disease (CVD) and mortality. Uremic cardiomyopathy, frequently observed in CKD and end-stage renal disease (ESRD), involves alterations in cardiac structure and function, which may reverse post-kidney transplantation, although data remain controversial. This study examines the relationship between graft function and changes in cardiac parameters pre- and post-transplantation in kidney transplant recipients. Methods: A total of 145 pediatric and adult recipients of living or deceased donor kidney transplants were enrolled at Gazi Yaşargil Training and Research Hospital. This cohort study utilized transthoracic echocardiographic (TTE) imaging pre-transplant and at least two years post-transplant. Echocardiographic parameters were analyzed using standard techniques. Results: The mean age of the participants was 35 years, with 60% male. The average dialysis duration prior to transplantation was 27 months. Most recipients (83.4%) received kidneys from living donors. Left ventricular diastolic dysfunction increased significantly post-transplant (p < 0.05), while other cardiac dimensions and functions, such as ejection fraction and pulmonary artery pressure, showed no significant change (p > 0.05). Notably, diastolic dysfunction worsened in patients with dysfunctional grafts (GFR < 45), correlating with increased pulmonary artery pressure post-transplant. The rate of antihypertensive drug use and the prevalence of diabetes mellitus increased significantly post-transplant (p < 0.05). Conclusions: This study demonstrates that left ventricular diastolic dysfunction present before kidney transplantation continues to persist post-transplantation in patients with end-stage renal disease undergoing chronic kidney disease treatment. Furthermore, it shows an increased rate of pulmonary artery pressure and pericardial effusion in patients with dysfunctional grafts after transplantation. Further research is required to explore strategies to reverse uremic cardiomyopathy and reduce cardiovascular risk in these patients.

Percutaneous Balloon Pericardiotomy and Window Creation for Treating Recurrent Massive Pericardial Effusion in Patients with Cancer: A Case Series and Literature Review

Cancer is the second leading cause of death worldwide, and pericardial effusion is relatively common in these patients. What constitutes the best therapeutic method for treating pericardial effusion in patients with cancer is controversial. Recent decades have witnessed the introduction of percutaneous balloon pericardiotomy, an effective and less-invasive method with lower recurrence rates than pericardiocentesis for draining pericardial effusion in patients with cancer who have a poor prognosis.We herein describe 2 patients with a history of metastatic melanoma and metastatic breast cancer, presenting with symptomatic massive pericardial effusions. The patients had experienced 2 episodes of cardiac tamponade in the preceding 4 to 5 months, treated via surgical drainage. In their current episode, they were both successfully treated via percutaneous balloon pericardiotomy, and there was no recurrence of significant pericardial effusion reported during the follow-up.

A Case Report of Video-assisted Thoracoscopic Pericardiectomy for Postpericardiotomy Recurrent Loculated Pericardial Effusion

Abstract Surgical drainage, particularly pericardiotomy, which has a low recurrence rate, can safely and efficiently treat symptomatic pericardial effusion in patients with cancer. A thoracoscopic video-assisted pericardiectomy is an effective treatment option for rare instances of recurrent localized pericardial effusion. A 63-year-old male presented with a rare form of recurrent pericardial effusion that was initially circumferential, but recurred in a loculated form. On the right side, a loculated pericardial effusion caused right ventricular dysfunction and lower leg edema. The patient’s clinical symptoms, especially severe pedal edema, improved significantly after video-assisted thoracoscopic surgery with pericardiectomy through the right chest wall. Infrequent instances of recurrent loculated pericardial effusion after pericardiotomy may manifest with atypical symptoms. In addition to echocardiography, chest computed tomography can be used to examine in great detail local lesions caused by postoperative pericardial adhesions or scarring. Video-assisted thoracic surgery improves visualization and effectively treats loculated pericardial effusion during pericardiectomy.

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.

The thyroid-pericardium connection: Unveiling the influence of hypothyroidism severity on pericardial effusion in South Gujarat's patient population-A cross-sectional study.

Hypothyroidism and pericardial effusion are two conditions that are associated with previous research. Nevertheless, the correlation between the severity of hypothyroidism and the occurrence of pericardial effusion remains uncertain. 1. To explore and examine the association between the severity of hypothyroidism and the occurrence of pericardial effusion. 2. To compare clinical characteristics and demographic factors with varying degrees of hypothyroidism severity and pericardial effusion. Tertiary care hospital and cross-sectional study using a pretested, semistructured questionnaire and echocardiography. The cross-sectional study encompassed a cohort of 60 patients diagnosed with hypothyroidism. Epi-info version 7.0 and Open epi version 3.1, Chi-square, mean, and standard deviation were used. There were 16 male participants, accounting for 26.7% of the total, and 44 female participants, constituting 73.3% of the cohort. The participants' average age was 35.5 years. Based on TSH levels, the severity of hypothyroidism in the study was classified into three categories: mild (33.4%), moderate (43.3%), and severe (23.3%). The most common symptoms were lethargy, weight gain, and cold intolerance. Also, an association between the severity of hypothyroidism and pericardial effusion was noted. This research established a noteworthy correlation between hypothyroidism severity and pericardial effusion incidence that is statistically significant. Nevertheless, no significant associations were detected with demographic factors or pulse rate. These results underscore the significance of monitoring and addressing pericardial effusion in patients with moderate-to-severe hypothyroidism. Further investigations are warranted to extend these findings.

Pericardial effusion in patients with chronic kidney disease: A two-center study.

Pericardial effusion (PE) is a prevalent form of pericardial involvement in chronic kidney disease (CKD). This study aims to investigate the clinical and laboratory features associated with PE severity in patients with CKD. In this cross-sectional study, we examined the medical records of patients admitted to tertiary hospitals with International Classification of Diseases 10th Revision (ICD-10) codes associated with CKD and PE. We included 112 CKD patients in stage 4 and 5 non-dialysis (ND) with PE for assessing the clinical and laboratory features of severity. Patients were divided into two categories based on the severity of PE. Seventy-two patients had mild and 40 had moderate and severe PE. Univariate analysis of demographic and laboratory features on the date of admission demonstrated that chest pain, dyspnea, serum albumin, and neutrophil-to-lymphocyte ratio (NLR) are associated with the severity of PE. The univariate analysis on the date of echocardiography showed significantly higher white blood cell count (WBC), neutrophil count (percentage and absolute count), and NLR, along with significantly lower lymphocyte percentage and serum albumin among patients with moderate and severe PE. In the multivariable analysis of laboratory features, on admission hypoalbuminemia (p-value = 0.014, OR = 4.03, CI: 1.32-12.25) and NLR greater than 5.5 (p-value = 0.015, OR = 4.22, CI: 1.32-13.50) were significantly associated with moderate and severe PE. In a parallel matter, at the time of echocardiography hypoalbuminemia (p-value = 0.004, OR = 5.38, CI: 1.74-16.65) and neutrophilia (p-value = 0.005, OR = 7.94, CI: 1.89-33.44) were significantly associated with moderate and severe PE. Despite advancements in the diagnosis and treatment of CKD, PE is still a concerning issue in these patients. This study revealed that hypoalbuminemia, neutrophilia, and NLR greater than 5.5 could be predictive factors of moderate and severe PE in CKD patients with PE. Further prospective study with larger sample size is needed to confirm these results.

Minoxidil Associated Pleural and Pericardial Effusion in Patient on Hemodialysis

Minoxidil is a medication used to treat hypertension by directly dilating the arteries. However, about 3% of patients who take this medication experience pericardial effusion, which can lead to large pleural effusions and may require pleuro pericardiocentesis. In rare cases, patients may develop seroconstrictive pericarditis. This report describes an elderly woman who developed seroconstrictive pericardial effusion and bilateral pleural effusion seven months after taking minoxidil therapy. It has also been reported that minoxidil used in dialysis patients can cause large-volume pleuro pericardial effusions, leading to seroconstrictive pericardial effusion and anasarca, which is not common. Therefore, if a patient is on dialysis and minoxidil and they have a pleural or pericardial effusion that is unresponsive to ultrafiltration, there is a possibility of minoxidil-associated polyserositis. It is important for healthcare providers to be aware of this potential adverse effect, as prompt discontinuation of the drug can save lives.

Pericardial Effusion Predicts Clinical Outcomes in Patients with COVID-19: A Nationwide Multicenter Study

Rationale and objectivesThe prognostic role of pericardial effusion (PE) in Covid 19 is unclear. The aim of the present study was to estimate the prognostic role of pericardial effusion in patients with Covid 19 in a large multicentre setting. Materials and methodsThis retrospective study is a part of the German multicenter project RACOON (Radiological Cooperative Network of the Covid 19 pandemic). The acquired sample comprises 1197 patients, 363 (30.3%) women and 834 (69.7%) men. In every case, chest computed tomography was analyzed for PE. Data about 30-day mortality, need for mechanical ventilation and need for intensive care unit admission were collected. Data were evaluated by means of descriptive statistics. Group differences were calculated with Mann-Whitney test and Fisher exact test. Uni-and multivariable regression analyses were performed. ResultsOverall, 46.4% of the patients were admitted to intensive care unit (ICU), mechanical lung ventilation was performed in 26.6%, and 30-day mortality was 24%.PE was identified in 159 patients (13.3%). The presence of PE was associated with 30-day mortality: HR = 1.54, CI95% (1.05; 2.23), p=0.02 (univariable analysis), and HR = 1.60, CI95% (1.03; 2.48), p=0.03 (multivariable analysis). Furthermore, density of PE was associated with the need for intubation (OR = 1.02, CI95% (1.003; 1.05), p=0.03) and the need for ICU admission (OR = 1.03, CI95% (1.005; 1.05), p=0.01) in univariable regression analysis. The presence of PE was associated with 30-day mortality in male patients, HR=1.56, CI95%(1.01-2.43), p=0.04 (multivariable analysis). In female patients, none of PE values predicted clinical outcomes. ConclusionThe prevalence of PE in Covid 19 is 13.3%. PE is an independent predictor of 30-day mortality in male patients with Covid 19. In female patients, PE plays no predictive role.

Management of Pericardial Effusion in Patients With Solid Tumor: An Algorithmic, Multidisciplinary Approach Results in Reduced Mortality After Paradoxical Hemodynamic Instability.

This study compared outcomes in patients with solid tumor treated for pericardial effusion with surgical drainage versus interventional radiology (IR) percutaneous drainage and compared incidence of paradoxical hemodynamic instability (PHI) between cohorts. Patients with advanced-stage solid malignancies may develop large pericardial effusions requiring intervention. PHI is a fatal and underreported complication that occurs following pericardial effusion drainage. Clinical characteristics and outcomes were compared between patients with solid tumors who underwent s urgical drainage or IR percutaneous drainage for pericardial effusion from 2010 to 2020. Among 447 patients, 243 were treated with surgical drainage, of which 27 (11%) developed PHI, compared with 7 of 204 patients (3%) who were treated with IR percutaneous drainage ( P =0.002); overall incidence of PHI decreased during the study period. Rates of reintervention (30-day: 1% vs 4%; 90-day: 4% vs 6%, P =0.7) and mortality (30-day: 21% vs 17%, P =0.3; 90-day: 39% vs 37%, P =0.7) were not different between patients treated with surgical drainage and IR percutaneous drainage. For both interventions, OS was shorter among patients with PHI than among patients without PHI (surgical drainage, median [95% confidence interval] OS, 0.89mo [0.33-2.1] vs 6.5mo [5.0-8.9], P <0.001; IR percutaneous drainage, 3.7mo [0.23-6.8] vs 5.0mo [4.0-8.1], P =0.044). With a coordinated multidisciplinary approach focusing on prompt clinical and echocardiographic evaluation, triage with bias toward IR percutaneous drainage than surgical drainage and postintervention intensive care resulted in lower incidence of PHI and improved outcomes.

Prognostic significance of pericardial effusion in systemic sclerosis-associated pulmonary hypertension: analysis from the PHAROS Registry.

Pulmonary hypertension (PH) is a leading cause of death in patients with SSc. The purpose of this study was to determine the prognostic significance of pericardial effusion in patients with SSc-PH. Pulmonary Hypertension Assessment and Recognition of Outcomes in Scleroderma (PHAROS) is a prospective multicentre registry which enrolled patients with newly diagnosed SSc-PH from 2005 to 2016. The prognostic impact of pericardial effusion status, including those who ever or never had pericardial effusion, and those who had persistent or intermittent pericardial effusion, was analysed. Kaplan-Meier survival analyses, log-rank test, and multivariable Cox proportional hazards regression were performed. Of the 335 patients with SSc-PH diagnosed by right heart catheterization and documentation of pericardial effusion presence or absence on echocardiogram, 166 (50%) ever had pericardial effusion. Ever having pericardial effusion was not predictive of survival (log-rank test P = 0.49). Of the 245 SSc-PH patients who had at least two echocardiograms, 44% had a change in pericardial effusion status over an average of 4.3 years of follow up. Having a persistent pericardial effusion was an independent predictor of survival [adjusted hazard ratio (aHR)=2.34, 95% CI 1.20, 4.64, P = 0.002], while intermittent pericardial effusion was not a predictor of survival (aHR = 0.89, 95% CI 0.52, 1.56, P = 0.68), in a multivariable-adjusted analysis. Persistent pericardial effusion, but not ever having had pericardial effusion or intermittent pericardial effusion, was independently associated with poorer survival. Incorporating information from serial echocardiograms may help clinicians better prognosticate survival in their SSc-PH patients.

Prevalence of pericardial effusion in autosomal dominant polycystic kidney disease.

Autosomal dominant polycystic kidney disease (ADPKD) has numerous extrarenal manifestations. Pericardial effusion (PE) may be an underrecognized complication with a reported prevalence of up to 35%. Our study is the first to systematically evaluate the prevalence of PE and associated risk factors in an ADPKD cohort outside the USA. Clinically stable ADPKD patients from a specialized outpatient clinic were evaluated retrospectively. Magnetic resonance tomography and computed tomography scans were analysed regarding the presence of PE (≥4mm). Imaging results were linked to clinical characteristics. Of 286 ADPKD patients, 208 had computed tomography or magnetic resonance imaging suitable for evaluation of PE. In this group we detected PE in 17 patients (8.2%). The overall prevalence of PE was 6.3%, with more females being affected (prevalence of PE was 7.8% in females and 3.8% in males). The PE mean size was 6.8±3.3mm. The prevalence of autoimmune diseases was higher in the patients with PE (11.8% versus 2.1%, P=.022), while the presence and size of PE was not associated with signs of rapid progressive disease, ADPKD genotype, patient age, body mass index and other clinical parameters. Exploratory investigation of individual characteristics of PE patients by regression tree analysis suggested renal functional impairment, sex and proteinuria as candidate variables. PE prevalence in our cohort was lower than previously reported and showed a clear female preponderance. Our data suggest that patients with PEs >10mm deserve further attention, as they may have additional non-ADPKD-related pathologies.

Evaluation of etiology of pericardial effusion in 81 patients who underwent pericardiostomy or pericardial window

&lt;b&gt;Introduction: &lt;/b&gt;A wide variety of diseases lead to pericardial effusion including systemic inflammatory diseases, pericarditis, reduced pericardial fluid reabsorption due to increased systemic venous pressure, pneumonia, pulmonary embolism, endocrine diseases, post-cardiotomy syndrome, trauma, hypothyroidism, renal-hepatic failure, collagen-vascular diseases, infectious, and malignancy. In this study, we aimed to evaluate the underlying etiology of pericardial effusions in patients underwent surgical pericardial drainage or pericardial window and contemporary management.&lt;br /&gt; &lt;b&gt;Materials and methods: &lt;/b&gt;Between January 2006 and January 2018, a total of 81 patients (49 males, 32 females; mean 52.9±10.6 years; range 5 to 84 years) who underwent subxiphoid pericardiostomy, pericardial window procedure with left anterior thoracotomy or subxiphoid approach, due to moderate or severe pericardial effusion and cardiac tamponade, were retrospectively analyzed.&lt;br /&gt; &lt;b&gt;Results: &lt;/b&gt;Malignancy was diagnosed either with histopathological examination of the pericardial biopsy and/or fluid in 17 (80.9%) of 21 patients had a previous history of malignancy. Of the 21 patients diagnosed with malignancy, six patients (7.5%) had leukemia/lymphoma, and six patients (7.5%) had thyroid papillary cancer. Mycobacterium tuberculosis was identified in only one (1.2%) patient’s culture of the pericardial fluid. No etiology was found in the remaining 38 patients (46.9%); thus, they were considered as idiopathic pericarditis.&lt;br /&gt; &lt;b&gt;Conclusion: &lt;/b&gt;Tuberculosis is no longer the leading cause of pericarditis. Idiopathic pericarditis is the leading cause of pericardial effusion and malignancy is the next most common cause of pericardial effusion in our region.

Outcomes of infective endocarditis in patients with and without pericardial effusion: a National Inpatient Sample study

Abstract Introduction Pericardial effusion (PE) in patients with infective endocarditis (IE) has been shown to be an independent risk factor for severe complications, however no significant association with mortality has been established. Our study aims to study the significance of pericardial effusion in patients with IE. Methods We performed a retrospective analysis using the United States National Inpatient Sample (NIS) database to identify all the hospital admissions with IE using ICD 10 codes and divided them into two groups based on the presence of PE. The outcomes of interest were in-hospital mortality, in-hospital complications, need for cardiac surgery, and length of stay (LOS). Results A total of 381,300 patients were hospitalized from 2016 to 2019 with IE, of whom 10,370 developed PE. Mean age of patients in the PE group was 51 years and in non-PE group was 61 years with males and Caucasian race being predominant in both groups. PE group had higher rates of in-hospital death (12.7% vs 9%, P≤0.001) and longer in-hospital stay (12 days vs 7 days, P≤0.001) compared to non-PE group. The rates of cardiac surgery were higher in PE group (26.1% vs 8.4%, P≤0.001). The rates of heart failure, heart block, renal failure, cardiogenic shock, and embolic stroke were higher in PE group [Table 1]. Conclusion Our study shows that presence of PE in patients with IE is a predictor for in-hospital mortality, length of stay, and need for cardiac surgery. Also, these patients are at higher risk for heart failure, heart block, cardiogenic shock and embolic stroke. Funding Acknowledgement Type of funding sources: None.

PRIMARY LUNG ADENOCARCINOMA PRESENTING AS CARDIAC TAMPONADE

PRIMARY LUNG ADENOCARCINOMA PRESENTING AS CARDIAC TAMPONADE

RARE CASE OF CONSTRICTIVE PERICARDITIS SECONDARY TO METASTATIC SQUAMOUS CELL CARCINOMA

RARE CASE OF CONSTRICTIVE PERICARDITIS SECONDARY TO METASTATIC SQUAMOUS CELL CARCINOMA

Unveiling the causes of pericardial effusion in a contemporary case series of pericardiocentesis in Latin America

Pericardial effusions requiring pericardiocentesis have multiple causes that vary among geographical regions and health contexts. This procedure can be performed for diagnostic or therapeutic indications. The purpose of this study was to identify the principal causes of pericardial effusions and indications for pericardiocentesis, exploring differences among groups. This was a retrospective case series of patients who underwent pericardiocentesis for pericardial effusion in a single center in Latin America. Demographic, clinical, echocardiographic, and procedural variables were recorded and analyzed. The primary outcome was to determine the causes of pericardial effusions in these patients and the indication (diagnostic, therapeutic, or both). The results are presented in two groups (inflammatory and noninflammatory) according to the cause of the pericardial effusion. One hundred sixteen patients with pericardial effusion underwent pericardiocentesis. The median age was 58 years (IQR 46.2–70.7), and 50% were male. In the noninflammatory pericardial effusion group, there were 61 cases (53%), among which neoplastic pericardial effusion was the most frequent cause (n = 25, 40.9%). In the inflammatory group, there were 55 cases (47%), and the main cause was postpericardiectomy syndrome after cardiac surgery (n = 31, 56.4%). The principal indication for pericardiocentesis was therapeutic (n = 66, 56.8%). Large pericardial effusion without hemodynamic effect of cardiac tamponade was significantly more frequent in the inflammatory group (p = 0.03). In conclusion, the principal cause of pericardial effusion in patients who underwent pericardiocentesis was postpericardiectomy syndrome after cardiac surgery, followed by neoplastic pericardial effusion. Pericardiocentesis is mainly a therapeutic procedure.

Pericardial Involvement in Severe COVID-19 Patients.

Background and Objectives: SARS-CoV-2 has an extensive tissue tropism due to its ability to attach to the surfaces of cells through different receptors, leading to systemic complications. In this article, we aim to present the prevalence of pericardial effusions in patients with severe COVID-19, to identify the risk factors/predictors for pericardial involvement, and to evaluate its impact on overall mortality. Materials and Methods: We enrolled 100 patients with severe COVID-19 in our observational cohort study and divided them in two groups: Group A (27 patients with pericardial effusion) and Group B (73 patients without pericardial effusion). We recorded demographic and lifestyle parameters, anthropometric parameters, clinical parameters, inflammation markers, respiratory function parameters, complete blood count, coagulation parameters, and biochemical serum parameters. All patients were evaluated by computer tomography scans within 48 h of admission. Results: The median age was 61 years in both groups and the male/female ratio was 3.5 vs. 2.8 in Group A vs. Group B. We identified mild pericardial effusion (3–4 mm) in 62.9% patients and moderate pericardial effusion (5–9 mm) in 37.1% patients, with a median value of 4 [3;6] mm. The patients with pericardial effusion presented with higher percentages of obesity, type-2 diabetes mellitus, arterial hypertension, and congestive heart failure, without statistical significance. Increased values in cardiac enzymes (myoglobin, CK, CK-MB) and LDH were statistically associated with pericardial effusion. The overall mortality among the participants of the study was 24% (24 patients), 33.3% in Group A and 20.8% in Group B. Conclusions: Pericardial effusion has a high prevalence (27%) among patients with severe forms of COVID-19 and was associated with higher mortality. Pericardial effusion in our study was not associated with the presence of comorbidities or the extent of lung involvement. Overall mortality was 60% higher in patients with pericardial effusion.

Outcomes of cardiac tamponade in patients with lung cancer.

e21083 Background: Cardiac tamponade is a serious complication of pericardial effusion and life-threatening cardio-oncological emergency. The prevalence of malignant pericardial effusion varies between 1% and 20% in autopsy studies. Primary lung cancer is the most common cause of metastatic tumor involving the pericardium. The common triggers for pericardial effusion in patients with lung cancer include cancer itself, chemotherapy and radiation therapy. The outcomes of cardiac tamponade in patients with lung cancer remain to be elucidated. Methods: We conducted a retrospective analysis of the 2016 to 2018 Nationwide Inpatient Sample. Adult patients with lung cancer and cardiac tamponade (age ≥ 18) were selected using the ICD-10 diagnosis code. Discharge-level weight analysis was used to produce a national estimate. A univariate and multivariable hierarchical regression analysis was performed to calculate the odds ratio (OR). Results: During the study period, 1,207,580 patients were admitted due to lung cancer of which 7,105 (0.6%) developed cardiac tamponade. Patients with cardiac tamponade tended to be younger (63.2 SE 0.3 vs 69.1 SE 0.2), male (54.5% vs 51.2%) and large proportion of radiation treatment (0.9% vs 0.7%), and smaller proportion of diabetes (18.5% vs 24.2%), chronic kidney disease (4.5% vs 7.6%) and heart failure (15.9% vs 16.2%). After adjusting for age, sex, comorbidity burden and heart failure, cardiac tamponade increased the risk for in-hospital mortality (OR 2.1; 1.9 – 2.5; p &lt; 0.001), major adverse cardiac events (OR 1.6; 1.3 – 2.1; p &lt; 0.001) and acute respiratory failure (OR 2.3; 2.0 – 2.5; p &lt; 0.001). Furthermore, cardiac tamponade was associated with longer length of stay (8.6 SE 0.2 vs 6.0 SE 0.01, p &lt; 0.001) and higher total hospital cost ($118,708.0 SE $4,027.1 vs $65,369.8 SE $170.6). Conclusions: In conclusion, patients with lung cancer who developed cardiac tamponade were associated with poor outcomes including higher in-hospital mortality, MACE, acute respiratory failure, a longer length of stay by 2.6 days, and higher cost of hospitalization. Cardiac tamponade was more common in males and patients who received radiation therapy. Further studies are warranted to develop an optimal management guideline for this cardio-oncological emergency.

P306 COVID–19 RELATED PERICARDITIS. CLINICAL IMPLICATIONS AND ROLE OF CARDIAC REHABILITATION IN SUBSEQUENT LONG–COVID SYNDROME

Acute pericarditis is considered one of the cardiovascular complications of COVID–19.Aim of the StudyThe aim was to evaluate the prevalence and clinical implications of acute pericarditis diagnosed through the presence of pericardial effusion in patients with COVID–19.MethodsThe investigation is a retrospective observational study enrolling patients admitted to ICU of Madonna del Soccorso Hospital (San Benedetto del Tronto, Italy) because of a SARS–Cov2 induced severe acute respiratory syndrome. N.170 patients, admitted from 1st april 2020 to 30th april 2021, were enrolled. All patients presented a variable picture of bilateral ground glass opacifications at HR– Chest CT. Some patients underwent oro–tracheal intubation+invasive ventilation. All patients underwent cardiological consultation including a transthoracic bedside echocardiogram, using ultrasound E9–GE machine (Boston, MA, USA). Demographic, laboratory and clinical data were collected for all enrolled patients.The diagnosis of acute pericarditis was defined by different degrees of pericardial effusion. All patient were divided in two groups: 1) pericarditis group (A); 2) pericarditis–free group (B).ResultsOf 170 enrolled patient, 51 were females (30%) and 119 were males (70%). Median age for all patients was 67,6 + 13,3 (females: 70,5 + 16,2; males: 66,4 + 11,7). Of 170, n. 60 patients had a diagnosis of acute pericarditis (32,2%) and were included into Group A [age 69,2 + 12,6; 39 (65%) males aged 69,3 + 10,6, 21 (35%) females aged 69,1 + 16,0]. Of 60, only 6 had a pericardial effusion >10 mm (10%); the remaining group A–patients (90%) had a mild pericardial effusion (<10 mm). No patient had tamponade picture. Group B (pericarditis–free) included 110 patients, aged 66,7 + 13,7, 80 (72,7%) males aged 65,0 + 12,1, 30 (27,3%) females aged 71,4 + 16,6. Group A–patients had more days of intubation and a prolonged hospital stay compared with group B, with a significant difference (p < 0.02 and p < 0,03 rispectively). N. 21 of 60 group A patients underwent a 7 weeks of CARDIAC REHABILITATION (CR) because of a LONG–COVID picture. In these patient a 6MWT was performed before and after CR. A significant increase of the walked distance after CR was found (from 352 + 21 to 498 + 31 – p < 0.03 – delta=41%).ConclusionPericarditis is a frequent cardiovascular complication of COVID–19 (32,2% in our study) with clinical and prognostic implications. CR is essential for long–term recovery in these patients.

Cytologic manifestations of Hodgkin lymphoma in serous effusions.

Serous effusions occur in a small group of patients with classic Hodgkin lymphoma (cHL). Most effusions are benign inflammatory fluids. Malignant effusionspredominantly in patients with treated relapsed diseases or rarely as a primary manifestation are diagnostically challenging to cytopathologists. Established cases of cHL with effusions were retrieved. Cytology slides were screened looking for Reed-Sternberg-Hodgkin (RSH) cells and patterns of background inflammatory cells. Cellblocks and their corresponding immunocytochemistry (ICC) slides were examined. The cytologic findings were correlated with nodal biopsy histopathologic and immunohistochemical features. We found six cases of benign and malignant pleural and pericardial effusions in patients with mediastinal nodular sclerosis-type cHL. Various cytomorphologic patterns were observed. Slides revealed sparsely scattered either isolated or aggregated mononuclear, binucleated and multinucleated RSH-like cells. Some may have been either disregarded as reactive mesothelial or histiocytic cells, or confused with other RSH-like malignant cells. The background varied between characteristic mixed inflammatory milieu, predominantly small lymphocytic or lymphohistiocytic with or without reactive mesothelial cells. Cytologic examination showed three positive cases (two cases with RSH cells confirmed by cellblock section ICC, one case with a mixed inflammatory infiltrate), and three benign effusions (one case with atypical RSH-like reactive mesothelial cells confirmed by ICC). Effusions associated with cHL exhibit different cytologic patterns. A high level of vigilance with utility of ICC has an important role in suspecting primary cases and confirming recurrences in known cases. The various cytologic patterns of cHL-associated benign and malignant effusions might reflect parallel pathophysiologic mechanisms.