Cancer, iatrogenic complications are usual causes of pericardiocentesis-treated effusions
Symptomatic pericardial effusions are most commonly caused by cancer and iatrogenic complications, results of a Singapore study in an academic medical centre have found. Nonetheless, success rate is high and complications are relatively low in pericardiocentesis.
In addition, “[p]rognosis … after pericardiocentesis is determined by the underlying cause of pericardial effusion,” researchers said.
This study included consecutive patients (n=149) undergoing pericardiocentesis at a single Asian academic medical centre. A comprehensive electronic medical records system was used to track patient demographics, echocardiographic findings, investigations, pericardiocentesis procedural details and clinical progress.
Malignancy (46.3 percent) and postsurgical complications (17.6 percent) were the most common cause of pericardial effusions in patients who underwent pericardiocentesis. Of the effusions, 77.3 percent were large and 69.8 percent had tamponade physiology. [Singapore J Med 2019;doi:10.11622/smedj.2019065]
Success rate of pericardiocentesis guided by echocardiography and fluoroscopy was 98.7 percent, with a complication rate of 2.1 percent. The aetiology of the pericardial effusion determined the odds of effusion recurrence and survival-to-discharge. Recurrence rate of malignant effusions was 24.6 percent, while survival rate at 12 months after discharge of a malignant pericardial effusion was 45.0 percent.
Furthermore, patients presenting with tamponade due to acute aortic syndromes and myocardial rupture due to ischaemic heart disease had the highest short-term mortality.
“Causes of pericardial effusion vary depending on the geographical location of the survey,” researchers said, noting that infections such as tuberculosis are the most common causes in less developed countries, whereas complications of cardiac surgery and cancer predominate in advanced countries. [Epidemiol Infect 2005;133:393-399; J Intern Med 2003;253:411-417; Am J Cardiol 2016;117:664-649]
“Furthermore, the proportions of pericardial effusions caused by malignancy and postsurgical complications may be increasing over time, in part due to improved survival among cancer patients and increasing number of cardiac interventions in developed countries,” they added. [Herz 2012;37:183-187]
Pericardial effusion prognosis is linked to its aetiology, according to researchers. Patients with malignant pericardial effusions have poor prognosis, with median survival of 3–7 months. [J Intern Med 2003;253:411-417; Herz 2015;40(Suppl 2):153-159; Clin Cardiol 2008;31:531-537; Am J Cardiol 2016;117:664-649]
These studies support the current findings, they said. However, patients with haemopericardium due to acute ascending aortic syndrome and free wall myocardial rupture had the worst short-term prognosis despite undergoing emergent surgery.
Although the present study was limited by its retrospective design, lack of a systematic protocol for pericardiocentesis and advanced investigations of the pericardial fluid, its findings show real-world practices are useful for further improvements in clinical care.
“Our results may have been biased due to the presence of tertiary cancer and cardiovascular surgical services within our institution due to which higher proportions of patients with malignant and postsurgical effusions would be referred for pericardiocentesis,” researchers said.