Pericardial Effusion Volume Research Articles

Hydropericardium in hypothyroidism. Features of the clinic, diagnosis and treatment

Thyroid hormone deficiency negatively affects the state of the cardiovascular system, causing the formation of a «myxedematous heart». The frequency and clinical features of primary hypothyroidism in 84 patients discharged from the endocrinology department of the RCH in 2017-2022 were retrospectively analyzed. Pericardial effusion was registered in 9 people (10.7%). Massive effusion with separation of pericardial leaflets from 30 to 50 mm and the threat of tamponade was in 4 out of 9 patients. Even with a large volume of pericardial effusion, classic symptoms such as shortness of breath, orthopnea, chest pain, and a feeling of fullness were absent or poorly expressed. Differential diagnosis with diseases accompanied by accumulation of fluid in the pericardial cavity was required. Indicators of thyroid status made it possible to associate the hydropericardium with decompensation or hypothyroidism for the first time. Thyroid hormone replacement therapy led to the disappearance of hypothyroidism symptoms and a decrease in the hydropericardium. With a high risk of tamponade in 3 patients, therapy was supplemented with pericardiocentesis. A clinical observation of successful treatment with thyroid hormones in combination with pericardiocentesis of severe newly diagnosed hypothyroidism against the background of autoimmune thyroiditis with massive pericardial effusion is presented.

Accidental cardiac puncture during pericardiocentesis in a dog

AbstractA 12‐year‐old, male, neutered, crossbreed dog, with a bodyweight of 7.6 kg, was diagnosed with a moderate volume of pericardial effusion with cardiac tamponade using point‐of‐care ultrasound. Initial bloodwork revealed moderate anaemia (packed cell volume 23%) and hyperlactataemia (2.3 mmol/L). During pericardiocentesis, accidental cardiocentesis and drainage of 16.5 mL/kg of blood occurred, resulting in an increased heart rate, hypotension and alterations in the electrocardiogram trace amplitude. The patient received 25 mL/kg of packed red blood cells, and was discharged from hospital the next day. Unfortunately, the pericardial effusion reoccurred 7 days later. The patient was diagnosed with an epicardial mass, and euthanased 48 hours later.

Transthoracic Color Doppler Ultrasound-Guided Grooved Negative Pressure Drainage Tube Implantation in Pericardial Effusion After Cardiac Surgery.

Pericardial effusion is a common complication without a standard postoperative effusion treatment after cardiac surgery. The grooved negative pressure drainage tube has many advantages as the emerging alternative for drainage of pericardial effusion, such as it changes the structure of the traditional side hole, uses the capillary function to ensure drainage smooth, etc. The purpose of this study was to assess the feasibility and effectiveness of transthoracic color Doppler ultrasound-guided grooved negative pressure drainage tube implantation in pericardial effusion after cardiac surgery. All patients with pericardial effusion after cardiac surgery who underwent transthoracic color Doppler ultrasound-guided grooved negative pressure drainage tube implantation between January 2019 and December 2021 were retrospectively analyzed. Treatment results (including clinical symptoms, effusion volume, color Doppler ultrasonography, and computed tomography scan) were investigated to evaluate the effectiveness and safety of this method. A total of 20 patients successfully underwent transthoracic color Doppler ultrasound-guided grooved negative pressure drainage tube implantation. After the operation, their symptoms (chest tightness, shortness of breath, etc.) were all relieved, and dark red or light red drainage fluid (> 200 ml) appeared in the newly placed drainage bottle. Color Doppler ultrasonography showed that the volume of pericardial effusion decreased significantly. The transthoracic color Doppler ultrasound-guided grooved negative pressure drainage tube is a safe and effective method for the treatment of postoperative pericardial effusion with less trauma, faster recovery, shorter in-hospital stay, and fewer complications.

Clinical outcomes of image-guided percutaneous drainage of pericardial effusion in cancer patients: A single-center retrospective analysis.

Catheter removal, survival, and recurrence rates after percutaneous pericardial effusion drainage in cancer patients are not fully understood. We evaluated the clinical outcomes of image-guided percutaneous pericardial effusion drainage in cancer patients. From January 2014 to September 2017, 113 percutaneous drainages for symptomatic pericardial effusion were performed in 100 cancer patients (median 60 years; range, 7-84 years) using ultrasound or angio-computed tomography. An 8-Fr drainage catheter was placed using the Seldinger technique via the subxiphoid (n=73), apical (n=23), or left parasternal (n=17) routes. Success rates, complications, and postprocedural clinical outcomes of drainages were retrospectively assessed. The technical and clinical success rates were 100% and 99%, respectively, without major complications. The median duration of catheterization and evacuated pericardial effusion volume were 6 days (range, 1-72 days) and 970ml (range, 140-7635ml), respectively. Catheters were removed after the first drainage in 86 cases (86%). Symptomatic pericardial effusion recurred in nine patients after catheter removal, in whom redrainages were performed 13 times with a median duration to redrainage time of 48 days (range, 13-529 days). During the follow-up period (median 106 days [range, 1-1396 days]), 61 patients died. The median survival was 140 days (95% confidence interval [CI], 95-276 days), and the median catheter-free survival was 111 days (95% CI, 60-152 days). Image-guided percutaneous pericardial effusion drainage for cancer patients is safe and helps alleviate symptoms. Additionally, catheter removal is possible in most patients, allowing a catheter-free period for patients.

IN A TIME OF VIRAL SPREAD, DON'T FORGET THE USUAL SUSPECTS

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: The diagnosis of lung malignancy can often be incidental. We present a hemodynamically unstable patient with COVID-19 and pericardial effusion, subsequently diagnosed with metastatic adenocarcinoma of the lung. CASE PRESENTATION: A 54-year-old male with no significant medical history was diagnosed with COVID-19 two weeks prior to presentation. He had dyspnea on exertion since that time and presented to the hospital after having an abnormal CXR and leukocytosis on out-patient testing. His blood pressure was 95/68 with a heart rate of 129. EKG revealed atrial fibrillation and electrical alternans. He had mildly elevated BNP and troponin, with lactic acidosis. Bilateral opacities were noted on CXR. A large effusion concerning for tamponade was noted on bedside echo. He underwent immediate pericardiocentesis and had 2L serosanguinous fluid drained. After initial stabilization, he was found to have extensive bilateral lower extremity DVT and PE.Repeat TTE showed residual effusion with tamponade physiology observed. Despite the findings on imaging, a pericardial window was not pursued due to concerns of anesthesia induction in the setting of a new PE. He underwent placement of a pericardial drain instead. After the procedure, heparin drip was initiated with an IVC filter placed soon after. The patient eventually had a pericardial window placed. His arrhythmia was chemically converted back to sinus rhythm. On POD5, the drains were removed.Autoimmune workup of the fluid was within normal limits, but cytology resulted in a diagnosis of adenocarcinoma positive for TTF-1. Thus, he was diagnosed with stage IV adenocarcinoma of the lung. CT revealed multiple lytic lesions with diffuse lymphadenopathy. MRI showed no evidence of brain metastasis. He was transitioned to apixaban at discharge, with out-patient oncology follow-up. DISCUSSION: A small study of 31 patients showed pericardial effusion was an independent risk factor predicting severity of COVID-19 infection, with reports of the virus being detected in pericardial fluid.[1,2] While virus infection can cause pericardial effusion, other causes should not be ignored in the workup. With hemodynamic instability, immediate intervention is warranted despite the risk involved with pericardiocentesis. In patients with large volume of pericardial effusion extracted, 5% of them will suffer from paradoxical hemodynamic instability and pulmonary edema afterwards, a condition known as pericardial decompression syndrome.[3] The increased venous return after decompression will compress the LV, based on the principle of ventricular coupling, reducing the cardiac output. Treatment for this condition is supportive. CONCLUSIONS: While COVID-19 is known to cause pericardial effusion, other causes, such as malignancy, should not be forgotten and should always remain in our differential. The risk involved with immediate pericardiocentesis goes beyond cardiac injury. REFERENCE #1: Chen Q, Xu L, Dai Y, et al. Cardiovascular manifestations in severe and critical patients with COVID -19. Clin Cardiol. 2020;43(7):796-802. REFERENCE #2: Farina A, Uccello G, Spreafico M, Bassanelli G, Savonitto S. SARS-CoV-2 detection in the pericardial fluid of a patient with cardiac tamponade. Eur J Intern Med. 2020;76:100-101. REFERENCE #3: Prabhakar Y, Goyal A, Khalid N, et al. Pericardial decompression syndrome: A comprehensive review. World J Cardiol. 2019;11(12):282-291. DISCLOSURES: No relevant relationships by Rumon Chakravarty, source=Web Response No relevant relationships by Vernon Chan, source=Web Response

The Use of Novel Non-Vitamin K Antagonist Oral Anticoagulants Following Closure of the Left Atrial Appendage: Preliminary Results of Clinical Follow-Up.

ObjectiveThe aim of this study was to investigate the safety and efficacy of using novel non-vitamin K antagonist oral anticoagulants (NOACs) for anticoagulation following left atrial appendage closure (LAAC).MethodsA total of 70 patients with non-valvular atrial fibrillation (NVAF) were enrolled in this study. All patients underwent successful LAAC between November 2018 and September 2019 in the Department of Cardiology of the First Affiliated Hospital of the University of Science and Technology of China. All patients subsequently completed a 45-day postoperative follow-up period. Patients were grouped according to the postoperative anticoagulation regimen they received: there were 40 patients in the NOACs group and 30 patients in the warfarin group. Baseline clinical data, intraoperative data, and short-term postoperative follow-up data were collected and the two groups were compared.ResultsThe intraoperative results showed no statistical difference between the two groups in respect of the occlusion rate, the compression ratio of the occluder, the volume of pericardial effusion, or the incidence of the following: residual shunts, device-related thromboses (DRT), stroke, and pericardial effusion (P > 0.05 in all cases). The residual shunt volume in the NOACs group was significantly smaller than that in the warfarin group (P = 0.04). During the 45-day postoperative follow-up period, there was no statistical difference between the two groups in respect of the residual shunt volume, or the incidence of DRT, ischemic stroke and cerebral hemorrhage (P > 0.05 in all cases). Compared with the warfarin group, the residual shunt volume was significantly reduced in the NOACs group (P = 0.03). The incidence of minor hemorrhage and the total hemorrhage incidence in the NOACs group were significantly lower than those in the warfarin group (5% vs 30%, P = 0.004, and 5% vs 33.3%, P = 0.002, respectively).ConclusionIn this study, the use of NOACs for postoperative anticoagulation therapy following LAAC did not increase the risk of embolization or hemorrhage during the short-term follow-up period.

Anticardiac antibodies in patients with severe and moderate COVID-19 (correlations with the clinical performance and prognosis)

The level and significance of anticardiac antibodies (ACA) in patients with COVID-19 infection have not yet been studied.Aim. To assess the level of various ACA in patients with severe and moderate COVID-19 infection and to identify the correlation of antibody profile with the clinical performance and prognosis.Material and methods. The study included 86 (38 women and 48 men) patients aged 20-90 years (60,2±16,6 years) who were hospitalized for moderate and severe COVID-19 infection in April-June 2020. Nasopharyngeal swab confirmed the disease in 59,3% of patients. In addition to the standard examination, electrocardiography and chest scan, level of antinuclear antibodies (ANA), antiendothelial cell antibodies (AECA), anti-cardiomyocyte antibodies, antibodies to anti-smooth muscles (ASMA) and cardiac conduction system fibers. Echocardiography was performed in 17 patients. Mean length of stay was 14 [12; 18] days. Death was considered as the primary endpoint.Results. Prevalence of heart disease and symptoms (including hypertension and coronary artery disease) was 45,3%. The manifestations of coronavirus heart damage include arrhythmias (supraventricular premature beats, 3,6%; atrial fibrillation, 9,3%), heart failure (9,3%), low QRS voltage (11,4%), repolarization abnormalities (41,9%), pericardial effusion (30%). An increase in troponin levels was observed in low number of patients. All types of cardiovascular disease correlated with the maximum D-dimer level (AUC, 0,752, p<0,01). Titers of two or more types of ACA were increased by 3 or more times in 25 (73,5%) patients. Significant (p<0,05) correlations of ANA level with cardiovascular symptoms/diseases in general (r=0,459), anti-cardiomyocyte antibodies — with the prevalence of pneumonia (r=0,472), shortness of breath severity (r=0,370), respiratory failure (r=0,387), oxygen therapy (r=0,388) and mechanical ventilation (r=0,469), as well as the presence of chest pain (r=0,374), QRS voltage decrease (r=0,415), maximum level of CRP (r=0,360) and LDH (r=0,360). ANA and anti-cardiomyocyte antibody levels strongly correlated with pericardial effusion (r=0,721 and r=0,745, respectively, p<0,05). The mortality rate was 9,3%. Heart failure was one of the death causes in 37,5%. The level of anti-cardiomyocyte antibodies and ASMA correlated with mortality (r=0,363, and r=0,426, p<0,05) and had a predictive value. Mortality in patients with cardiovascular disease was 17,9%, without — 2,2% (p<0,05). The most powerful predictive model for COVID-19 adverse outcomes includes age, diabetes, oxygen therapy extent, maximum leukocyte, C-reactive protein and D-dimer levels. However, a model that includes only age, diabetes, and cardiovascular disease also has sufficient predictive power (correlation coefficient, 0,568, p<0,001).Conclusion. An increase in ACA titers was detected in 73,5% of patients, correlated with mortality, in most cases reflects the general activity and severity of the disease and can be regarded as part of response in COVID-19. At the same time, a direct correlation with signs of myocardial damage, the presence and volume of pericardial effusion confirms the direct role of ACA in the development of myopericarditis.

Long-Term Outcome of Pericardial Drainage in Cases of Chronic, Large, Hemodynamically Insignificant, C-Reactive Protein Negative, Idiopathic Pericardial Effusions

Pericardial effusion (PE) prognosis depends on the underlying etiology. We sought to assess the outcome of patients with chronic (>3 months), large (diastolic echo-free space >2 cm), idiopathic (without apparent etiology), C-reactive protein (CRP) negative PE, a topic where data are lacking. A total of n = 74 patients were enrolled in this study. Patients were treated by pericardiocentesis (n = 39) or surgical pericardial "window" (PW) (n = 13) or conservatively (n = 22). The median follow-up was 24 months (interquartile range: 15 to 38). Among those patients who had PE drained (n = 52), PE re-accumulation occurred in 32 cases (61.5%) and the rate was significantly higher in the pericardiocentesis subgroup (76.9% for pericardiocentesis vs 15.4% for PW group, p <0.001). Patients with re-accumulation had longer disease duration (32.1 ± 25.7 months vs 19.5 ± 23.8 months, p = 0.01), higher maximum PE diameter (32.2 ± 9.4 mm vs 26.1 ± 4.9 mm, p = 0.003) and larger PE volume drained at baseline (1,912 ± 707 mL vs 1,508 ± 387 mL, p = 0.04). Large PE re-accumulation occurred in 41% of patients who underwent pericardiocentesis and in 7.7% of those who underwent PW. In Cox survival analysis the only independent predictor of fluid re-accumulation was the type of intervention, with PW being associated with significantly reduced risk (hazard ratio 0.115, 95% confidence interval 0.015 to 0.875, p = 0.037). Major complications needing treatment were recorded in 12.8% and 15.4% (p = 0.999) of patients who underwent pericardiocentesis and PW, respectively. Moreover, invasive procedures were not helpful in establishing new diagnoses and guide treatment. In conclusion, in asymptomatic patients with chronic, large, hemodynamically insignificant, CRP negative, idiopathic PE, conservative management seems a more reasonable approach in most cases.

Echocardiographic Assessment of Pericardial Effusion Size: Time for a Quantitative Approach

Guidelines for the transthoracic echocardiographic (TTE) assessment of pericardial effusion size rely on linear measurements of the largest width of the effusion at end diastole. 1 Klein Klein A.L. Abbara S. Agler D.A. Appleton C.P. Asher C.R. Hoit B. et al. American Society of Echocardiography clinical recommendations for multimodality cardiovascular, imaging of patients with pericardial disease. J Am Soc Echocardiogr. 2013; 26: 965-1012 Abstract Full Text Full Text PDF PubMed Scopus (424) Google Scholar Using this system, effusion sizes are graded as small (<10 mm), moderate (10-20 mm), or large (>20 mm). This classification system is subject to potential errors due to variations in heart size, shifts in fluid location during the cardiac cycle, and the highly asymmetric nature of many effusions. Guidelines do not specify which view to use for measurements or how to deal with asymmetric fluid collections. There is limited research on using volumetric approaches to estimating pericardial effusion size. 2 Prakash A.M. Sun Y. Chiaramida S.A. Wu J. Lucariello R.J. Quantitative assessment of pericardial effusion volume by two-dimensional echocardiography. J Am Soc Echocardiogr. 2003; 16: 147-153 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar , 3 Khosraviani K. Goldberg Y. Salari B. Nezami N. Peng C.F. Taub C.C. The biplane modified Simpson's method accurately estimates pericardial effusion volume: a comparison with pericardiocentesis. Echocardiography. 2015; 32: 1215-1220 Crossref PubMed Scopus (3) Google Scholar , 4 Leibowitz D. Perlman G. Planer D. Gilon D. Berman P. Bogot N. Quantification of pericardial effusions by echocardiography and computed tomography. Am J Cardiol. 2011; 107: 331-335 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar We hypothesized that a quantitative assessment of pericardial effusion volume would be superior to conventional linear measurements of effusion size. We compared the two approaches to the actual volume of the effusion determined at the time of pericardial drainage.

ECHOCARDIOGRAPHIC ASSESSMENT OF PERICARDIAL EFFUSION SIZE: TIME FOR A QUANTITATIVE APPROACH

Guidelines for the echocardiographic assessment of pericardial effusion (PE) size rely on linear measurements of the largest width of the effusion. This approach is subjective and limited due to variations in heart size and the asymmetry of many effusions. We quantified PE volume using the method of

Prevalence of vomiting in dogs with pericardial effusion.

Pericardial effusion (PE) is common in dogs. Clinical signs may be vague until cardiac tamponade and associated cardiovascular decompensation develops. Vomiting has previously been identified in some dogs, but the actual prevalence of vomiting in dogs with PE is unknown. The purpose of this study is to report the prevalence of vomiting associated with PE, and to determine if vomiting is associated with the underlying cause of effusion, presenting plasma lactate concentration, or volume of PE removed. The medical records of 49 dogs diagnosed with PE were restrospectively reviewed. Data collected from the medical record included signalment, the presence or absence of vomiting, presenting plasma lactate concentration, and the etiology of the PE. Twenty-five of 49 dogs (51%) identified with PE had recently vomited. Vomiting was more common in dogs with presenting plasma lactate concentration > 5.0 mmol/L (P = 0.02) but was unrelated to the specific etiology of the PE. The volume of PE obtained via pericardiocentesis did not differ (P = 0.79) between dogs with (8.7 ± 3.4 mL/kg) and without historical vomiting (9.1 ± 4.3 mL/kg). Vomiting is common in dogs with PE, and in particular, dogs with evidence of hypoperfusion. Pericardial effusion should be included as a differential diagnosis in dogs with a history of vomiting that present with weakness or collapse.

The use of the diaphragmatico-hepatic (DH) views of the abdominal and thoracic focused assessment with sonography for triage (AFAST/TFAST) examinations for the detection of pericardial effusion in 24 dogs (2011-2012).

To evaluate the clinical usefulness of the diaphragmatico-hepatic (DH) view of the abdominal and thoracic focused assessment with sonography for triage (AFAST/TFAST) in detecting pericardial effusion (PE) in dogs. Retrospective case series from 2011 to 2012. Private practice emergency and critical care hospital. Twenty-four dogs with PE diagnosed by FAST. None. Fifty-two medical records from October 1, 2011 through September 30, 2012 had the terms "PE" within the medical record. Twenty-four dogs were diagnosed with PE by FAST with entries for the DH view. Of the 24 dogs, 7 had abdominal FAST, 6 had thoracic FAST (TFAST), and 11 had both exams performed. PE was noted on the DH view in 20 of 24 (83%) cases. Subjective PE volume assessment ranged from trivial (<5 mm) to severe. Of the 4 cases in which PE was absent via the DH view, PE was seen during the same exam at the TFAST pericardial views (n = 2) or detected on serial exam at the DH view (n = 2). The PE volume that was missed via the DH view was characterized as trivial (<5 mm; n = 1), mild (n = 1), and moderate (n = 2). The DH view of FAST was found to be clinically helpful for the detection of PE. Veterinarians should make it routine practice and part of FAST training to look into the thorax via the DH view during both abdominal FAST and TFAST exams.

Colchicine for postoperative pericardial effusion: a multicentre, double-blind, randomised controlled trial

ObjectivesPericardial effusion is common after cardiac surgery. Growing evidence suggests that colchicine may be useful for acute pericarditis, but its efficacy in reducing pericardial effusion volume postoperatively has not been...

Predictive Factors of Pericardial Effusion After a First Acute Myocardial Infarction and Successful Reperfusion

The aim of the study was to identify the determinants of pericardial effusion (PE) after a first myocardial infarction (MI). Cardiac magnetic resonance enables early analysis of multiple post-MI parameters; 193 patients with a first ST-elevation MI admitted to the Angers University Hospital (France) were enrolled prospectively. Cardiac magnetic resonance was performed at baseline (median of 5days [4 to 7]) and repeated at a 3-month follow-up to investigate left ventricular (LV) volumes, LV ejection fraction, infarct size, microvascular obstruction (MVO), systolic wall stress (SWS), and PE presence and extent. A 1-year follow-up was also performed. Overall, 113 patients (58.5%) showed a PE with a median size of 31.6 ± 24.0ml in the event that a PE was present. Patients with PE typically presented larger initial infarct sizes and LV volumes, and higher SWS, with more depressed LV ejection fraction and more frequent MVO and pleural effusions. Patients with PE exhibited higher rates of heart failure during hospitalization. At follow-up, there was no relevant PE, with no pericardiocentesis required. The multivariate analysis revealed SWS (odds ratio [OR] 1.092 [95% CI 1.007 to 1.184], p= 0.042), infarct size (OR 1.048 [95% CI 1.014 to 1.083], p= 0.003), and MVO extent (OR 1.274 [95% CI 1.028 to 1.579], p= 0.018) to be independent predictors for PE presence and volume. One patient died of LV free wall rupture during initial hospitalization, with only "small" PE found. In conclusion, infarct size, MVO, and SWS were independently related to PE presence and volume. Post-MI PE was found in 58.5% of cases, being regressive at follow-up. Among these patients with early reperfusion and optimal medical therapy, PE volume did not seem to be related to future clinical events.

Motion artifacts on coronary CT angiography images in patients with a pericardial effusion

BackgroundPatients with a pericardial effusion can have a pendulum-like movement of the heart. No reports associate the presence of pericardial fluid with coronary CT angiography (CTA) images that are degraded by motion artifact. ObjectiveWe tested the hypothesis that patients with pericardial effusion have coronary CTA images compromised by motion artifacts, even when other known causes of motion artifact in coronary imaging are minimized. MethodsAmong the prospectively electrocardiogram-gated single heart beat 320-detector row coronary CTA studies performed from September 2009 to May 2013, 13 consecutive studies acquired with a heart rate <60 beats/min that indicate a pericardial effusion formed an effusion cohort. A control cohort included 13 studies with no pericardial fluid performed by the same CT scanner; these were pair-matched to the effusion cohort for heart rate, sex, age, and body mass index. All studies were free of arrhythmia and respiratory motion. Motion artifact was separately assessed (3-point scale) at 8 coronary segments by 2 cardiovascular imaging teams. ResultsThe mean pericardial effusion volume for the effusion cohort was 129 ± 57 mL (range, 39–222 mL). Intra-observer/interobserver reproducibility of the motion artifact scores were good (κ = 0.636–0.791). Motion artifacts were more frequently observed in the effusion cohort for the left circumflex (no, mild, severe artifact, 54%, 46%, 0% vs 81%, 19%, 0%, respectively, for effusion vs control; P = .039) and right coronary arteries (no, mild, severe artifact = 41%, 44% 15% vs 79%, 21%, 0%, respectively, for effusion vs control; P < .001), especially for the middle or distal segments. Larger effusion volumes were associated with more severe motion artifacts. ConclusionPatients with pericardial effusion have coronary CTA images compromised by cardiac motion artifacts, particularly in the left circumflex and right coronary arteries.

A New Formula for Rapid Assessment of Pericardial Effusion Volume by Computed Tomography

The aim of this study was to evaluate a new formula for the rapid assessment of pericardial effusion (PE) volume by computed tomography. Twenty computed tomographic scans positive for PE were reviewed by two observers. Diameters of PE were measured at four locations. Additionally, PE volume was assessed by volumetry. The correlation between PE diameters and volume was evaluated, and a linear equation was derived for each diameter location. To test validity and reliability of the measurements, intraclass correlation and Bland-Altman analysis were performed. Good validity was expressed by strong correlations between diameter measurements at all four locations and PE volume (all R values >0.80 and P values <.0001). Intraclass correlation (all coefficients >0.75) and Bland-Altman analysis revealed good interobserver and intraobserver reliability of diameter measurements. The best values were observed for apical diameter measurements. The following linear equation was derived for apical diameter measurements: PE volume = 296 (mL/cm) × apical diameter (cm) - 32 mL. PE volume can rapidly be assessed by apical PE diameter measurement using the simplified formula PE volume = 0.3 (L/cm) × apical diameter (cm).

Quantification of Pericardial Effusions by Echocardiography and Computed Tomography

Echocardiography is a well-accepted tool for the diagnosis and quantification of pericardial effusion (PEff). Given the increasing use of computed tomographic (CT) scanning, more PEffs are being initially diagnosed by computed tomography. No study has compared quantification of PEff by computed tomography and echocardiography. The objective of this study was to assess the accuracy of quantification of PEff by 2-dimensional echocardiography and computed tomography compared to the amount of pericardial fluid drained at pericardiocentesis. We retrospectively reviewed an institutional database to identify patients who underwent chest computed tomography and echocardiography before percutaneous pericardiocentesis with documentation of the amount of fluid withdrawn. Digital 2-dimensional echocardiographic and CT images were retrieved and quantification of PEff volume was performed by applying the formula for the volume of a prolate ellipse, π × 4/3 × maximal long-axis dimension/2 × maximal transverse dimension/2 × maximal anteroposterior dimension/2, to the pericardial sac and to the heart. Nineteen patients meeting study qualifications were entered into the study. The amount of PEff drained was 200 to 1,700 ml (mean 674 ± 340). Echocardiographically calculated pericardial effusion volume correlated relatively well with PEff volume (r = 0.73, p <0.001, mean difference -41 ± 225 ml). There was only moderate correlation between CT volume quantification and actual volume drained (r = 0.4, p = 0.004, mean difference 158 ± 379 ml). In conclusion, echocardiography appears a more accurate imaging technique than computed tomography in quantitative assessment of nonloculated PEffs and should continue to be the primary imaging in these patients.

Severe Pericardial Effusion in Patients with Concurrent Malignancy: A Retrospective Analysis of Prognostic Factors Influencing Survival

The treatment of massive and/or symptomatic pericardial effusion in patients with cancer remains a subject of discussion. Medical and surgical management have been proposed. In the present study, we aimed to determine the prognostic factors influencing survival of cancer patients admitted in intensive care unit (ICU) with severe pericardial effusion to better select the treatment strategies. All patients with cancer and massive or symptomatic pericardial effusion were retrospectively analyzed. Patients were followed up until death or last time known to be alive. Univariate and multivariate analyses were performed to determine prognostic factors influencing survival. Between January 1999 and August 2004, 55 eligible patients were admitted in the ICU for pericardial effusion, including 30 with lung cancer, 9 with breast cancer, 5 with hematological malignancies, and 11 patients with other types of solid tumors. Forty-three patients underwent a surgical drainage. No operative death occurred. Four patients presented with an asymptomatic recurrence. Median survival of the entire group was 112 days. Survival rates for 1, 2, and 3 years were 27%, 17%, and 12%, respectively. In univariate analysis, the following variables were significantly associated with a reduced survival: histopathological diagnosis of malignant pericardial effusion, age (>60 years), the volume of pericardial effusion (<550 cc), and the cancer status (complete or partial response). After multivariate analysis, the cancer status was the only statistically significant clinical factor influencing overall survival (P = .005). In this series of patients presenting with severe pericardial effusion, the control of the underlying neoplasm was the only significant factor influencing survival and could be helpful in making decision to the optimal (invasive) treatment that should balance treatment efficacy with life expectancy.

The anteroposterior pericardial sac diameter measured by echocardiography correlates with the volume of pericardial effusion and with effort dyspnea

To examine the value of the anteroposterior pericardial sac diameter (APD) for prediction of the volume of pericardial effusion. We measured the APD by echocardiography before 52 pericardiocentesis procedures and correlated it with the aspirate volume, etiology, symptoms, and clinical outcome. The volume of the aspirate ranged from 60 to 2300 ml (median 650 ml). The APD (range 8.0 cm-15.9 cm, median 12 cm) correlated well with the cubic root of the volume of the effusion [volume=(0.8APD-0.6)3, r2=0.533, p<0.01]. An APD>or=12 cm had a positive predictive value of 88% and a negative predictive value of 83% for effusion volume above the sample median (>or=650 ml) and a positive predictive value of 100% for effusion in the middle or upper aspirate volume tertiles. Effort dyspnea was more common among patients with APD>or=12.0 cm (n=13) than in those with APD<12.0 cm (n=11) (p=0.007). One-year survival after pericardiocentesis was closely related to the severity of the underlying etiology and was not influenced by the volume of the effusion before aspiration. The APD is a simple, valuable method for non-invasive prediction of pericardial fluid volume. A greater APD is associated with, and may explain, effort dyspnea.

The Importance of Intrapericardial Drain Selection in Cardiac Surgery

To explore the impact of intrapericardial and infracardiac drains on pericardial effusions in cardiac surgery. Patients undergoing coronary artery bypass grafting were randomized into two groups. At the end of the intervention, an intrapericardial and infracardiac Blake drain was placed in patients in group 1 (n = 97), and an intrapericardial and infracardiac semirigid drain was placed in patients in group 2 (n = 105). In addition, a semirigid drain was placed into mediastinum in all cases. The amount of drainage was calculated at six different time points postoperatively: postoperative 0 to 2 h, postoperative 2 to 4 h, postoperative 4 to 6 h, postoperative 6 to 12 h, postoperative 12 to 24 h, and postoperative 24 to 48 h. The amount of pericardial effusion was estimated by transthoracic echocardiography after the drains were removed. In all measurements, the amount of drainage from intrapericardial Blake drains was higher, the total amount of drainage being equal to 330.7 +/- 29.4 mL and 193.2 +/- 19.6 mL in the Blake drain and semirigid drain groups, respectively (p = 0.000) [mean +/- SD]. When the drains were removed, the volume of pericardial effusion was 3.86 +/- 0.76 mm in Blake drain group and 7.59 +/- 1.16 mm in semirigid drain group (p = 0.000). The incidence of postoperative atrial fibrillation was 11.3% in the group with Blake drains, and 23.8% in the group with semirigid drains (p = 0.016). The more effective drainage obtained with infracardiac Blake drains compared to semirigid drains helps to reduce the amount of postoperative pericardial effusion and the risk of atrial fibrillation.