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Vasquez MA, Iskander M, Mustafa M, Quintero-Martinez JA, Luna A, Mintz J, Noy J, Uribe J, Mijares I, de Marchena E, Chatzizisis YS. Pericardiocentesis Outcomes in Patients With Pulmonary Hypertension: A Nationwide Analysis from the United States. Am J Cardiol 2024; 210:232-240. [PMID: 37875232 DOI: 10.1016/j.amjcard.2023.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 10/26/2023]
Abstract
Pericardiocentesis (PC) in patients with pulmonary hypertension (PH) and pericardial effusions has unclear benefits because it has been associated with acute hemodynamic collapse and increased mortality. Data on in-hospital outcomes in this population are limited. The National Inpatient Sample database was used to identify adult patients who underwent PC during hospitalizations between 2016 and 2020. Data were stratified by the presence or absence of PH. A multivariate regression model and case-control matching was used to estimate the association of PH with PC in-hospital outcomes. A total of 95,665 adults with a procedure diagnosis of PC were included, of whom 7,770 had PH. Patients with PH tended to be older (aged 67 ± 15.7 years) and female (56%) and less frequently presented with tamponade (44.9% vs 52.4%). Patients with PH had significantly higher rates of chronic kidney disease, coronary artery disease, heart failure, and chronic lung disease, among other co-morbidities. In the multivariate analysis, PC in PH was associated with higher all-cause mortality (adjusted odds ratio [aOR] 1.40, confidence interval [CI] 1.30 to 1.51) and higher rates of postprocedure shock (aOR 1.53, CI 1.30 to 1.81) than patients without PH. Mortality was higher in those with pulmonary arterial hypertension than other nonpulmonary arterial hypertension PH groups (aOR 2.35, 95% CI 1.46 to 3.80, p <0.001). The rates of cardiogenic shock (aOR 1.49, 95% CI 1.38 to 1.61), acute respiratory failure (aOR 1.56, 95% CI 1.48 to 1.64), and mechanical circulatory support use (aOR 1.86, 95% CI 1.63 to 2.12) were also higher in patients with PH. There was no significant volume-outcome relation between hospitals with a high per-annum pericardiocentesis volume compared with low-volume hospitals in these patients. In conclusion, PC is associated with increased in-hospital mortality and higher rates of cardiovascular complications in patients with PH, regardless of the World Health Organization PH group.
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Affiliation(s)
- Moises A Vasquez
- Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida.
| | - Mina Iskander
- Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Mohammed Mustafa
- Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Juan A Quintero-Martinez
- Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Antonio Luna
- Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Joel Mintz
- Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Jose Noy
- Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Juan Uribe
- Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Ivan Mijares
- Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Eduardo de Marchena
- Departments of Medicine, University of Miami Miller School of Medicine, Miami, Florida; Division of Cardiovascular Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Yiannis S Chatzizisis
- Departments of Medicine, University of Miami Miller School of Medicine, Miami, Florida; Division of Cardiovascular Medicine, University of Miami Miller School of Medicine, Miami, Florida
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Harfouch B, Garcia M, Tolan S, Mantha Y, Hammadah M, Chilton R, Prasad A. Coronary Artery Perforation: A Rare Serious Complication of Pericardiocentesis. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100409. [PMID: 39131474 PMCID: PMC11308111 DOI: 10.1016/j.jscai.2022.100409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/06/2022] [Accepted: 06/27/2022] [Indexed: 08/13/2024]
Affiliation(s)
- Badr Harfouch
- Department of Medicine, Division of Cardiology, UT Health San Antonio, San Antonio, Texas
| | - Marlene Garcia
- Department of Medicine, Division of Cardiology, UT Health San Antonio, San Antonio, Texas
| | - Scott Tolan
- Department of Medicine, Division of Cardiology, UT Health San Antonio, San Antonio, Texas
| | - Yogamaya Mantha
- Department of Medicine, Division of Cardiology, UT Health San Antonio, San Antonio, Texas
| | - Muhammed Hammadah
- Department of Medicine, Division of Cardiology, UT Health San Antonio, San Antonio, Texas
| | - Robert Chilton
- Department of Medicine, Division of Cardiology, UT Health San Antonio, San Antonio, Texas
| | - Anand Prasad
- Department of Medicine, Division of Cardiology, UT Health San Antonio, San Antonio, Texas
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Alnsasra H, Case BC, Yang M, Rogers T, Satler LF, Asch FM, Waksman R, Kumar P, Ben-Dor I, Medvedofsky D. Pericardiocentesis induced right ventricular changes in patients with and without pulmonary hypertension. Echocardiography 2021; 38:752-759. [PMID: 33835611 DOI: 10.1111/echo.15046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/09/2021] [Accepted: 03/29/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Pericardial effusion drainage in patients with significant pulmonary hypertension (PH) has been questioned because of hemodynamic collapse concern, mainly because of right ventricular (RV) function challenging assessment. We aimed to assess RV function changes related to pericardiocentesis in patients with and without PH. METHODS Consecutive patients with symptomatic moderate-to-large pericardial effusion who had either echocardiographic or clinical signs of cardiac tamponade and who underwent pericardiocentesis from 2013 to 2018 were included. RV speckle-tracking echocardiography analysis was performed before and after pericardiocentesis. Patients were stratified by significant PH (pulmonary artery systolic pressure [PASP] ≥50 mm Hg). RESULTS The study cohort consisted of 76 patients, 23 (30%) with PH. In patients with PH, both end-diastolic and end-systolic areas (EDA, ESA) increased significantly after pericardiocentesis (22.6 ± 8.0 cm2 -26.4 ± 8.4 cm2 , P = .01) and (15.9 ± 6.3 cm2 -18.7 ± 6.5 cm2 , P = .02), respectively. However, RV function indices including fractional area change (FAC: 30.6 ± 13.7%-29.1 ± 8.8%, P = .61) and free-wall longitudinal strain (FWLS: -16.7 ± 6.7 to -15.9 ± 5.0, P = .50) remained unchanged postpericardiocentesis. In contrast, in the non-PH group, after pericardiocentesis, EDA increased significantly (20.4 ± 6.2-22.4 ± 5.9 cm2 , P = .006) but ESA did not (14.9 ± 5.7 vs 15.0 ± 4.6 cm2 , P = .89), and RV function indices improved (FAC 27.9 ± 11.7%-33.1 ± 8.5%, P = .003; FWLS -13.6 ± 5.4 to -17.2 ± 3.9%, P < .001). CONCLUSION Quantification of RV size and function can improve understanding of echocardiographic and hemodynamic changes postpericardiocentesis, which has the potential to guide management of PH patients with large pericardial effusion.
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Affiliation(s)
- Hilmi Alnsasra
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Michael Yang
- Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Toby Rogers
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA.,Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Federico M Asch
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | - Preetham Kumar
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Diego Medvedofsky
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA
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Abstract
PURPOSE OF REVIEW Abnormal accumulation of pericardial fluid is a common cardiac condition with different etiologies. Draining of the pericardial fluid (pericardiocentesis) is often indicated for diagnostic and therapeutic purposes and is performed in an elective or emergent setting. Echocardiography is the primary imaging method for diagnosing, localizing, and quantifying pericardial effusion as well as evaluating its hemodynamic effects, including the presence of cardiac tamponade. In this manuscript, we review the indications for pericardiocentesis and provide practical step-by-step guidance for echo-guided pericardiocentesis. RECENT FINDINGS Echo-guidance is an effective method to improve the safety and efficacy of pericardiocentesis. In experienced hands and with a stepwise approach, procedural outcomes are excellent, and complication rates are very low. Asymptomatic small idiopathic effusions have a benign course and can be left untreated. Prolonged drainage with an indwelling pericardial catheter is key for preventing fluid re-accumulation, and the use of colchicine to prevent fluid recurrence is encouraged whenever possible. Understanding how to evaluate the significance of a pericardial effusion as well as the procedural steps in the performance of a pericardiocentesis are essential for optimal outcomes in treating patients with pericardial effusions and tamponade.
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Affiliation(s)
- Nir Flint
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente, AHSP, Los Angeles, CA, 90048, USA.,Department of Cardiology, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Robert J Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente, AHSP, Los Angeles, CA, 90048, USA.
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