1
|
Lazarou E, Vlachopoulos C, Antonopoulos A, Imazio M, Brucato A, Tsioufis C, Lazaros G. Asymptomatic Chronic Large Pericardial Effusions: To Drain or to Observe? J Clin Med 2024; 13:3887. [PMID: 38999452 PMCID: PMC11242720 DOI: 10.3390/jcm13133887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/09/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
Pericardial effusions, especially large ones, have traditionally been regarded with concern by clinicians due to the sometimes unpredictable development of life-threatening cardiac tamponade. In the European Society of Cardiology Guidelines on pericardial diseases, the simplified algorithm for pericardial effusion triage and management recommends pericardial drainage in cases of cardiac tamponade and/or suspicion of bacterial or neoplastic etiology. In the presence of acute pericarditis, empiric anti-inflammatory treatment should be given, while when a specific indication known to be associated with pericardial effusion is found, then treatment of the underlying cause is indicated. Notably, the most challenging subgroup of patients includes those with large, asymptomatic, C-reactive-protein-negative, idiopathic effusions. In the latter subjects, pericardial drainage is proposed in cases of chronic effusions (lasting more than three months). However, this recommendation is based on scant data stemming from small-sized non-randomized studies. Nevertheless, recent evidence in a larger cohort of patients pointed out that a watchful waiting strategy is a safe option in terms of complication-free survival. This review summarizes the contemporary evidence on this challenging topic and provides recommendations for tailoring individual patient treatments.
Collapse
Affiliation(s)
- Emilia Lazarou
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece; (E.L.); (C.V.); (A.A.); (C.T.)
| | - Charalambos Vlachopoulos
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece; (E.L.); (C.V.); (A.A.); (C.T.)
| | - Alexios Antonopoulos
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece; (E.L.); (C.V.); (A.A.); (C.T.)
| | - Massimo Imazio
- Department of Medicine (DMED), University of Udine, 33100 Udine, Italy;
- Cardiothoracic Department, University Hospital Santa Maria della Misericordia, 33100 Udine, Italy
| | - Antonio Brucato
- Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy;
| | - Costas Tsioufis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece; (E.L.); (C.V.); (A.A.); (C.T.)
| | - George Lazaros
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece; (E.L.); (C.V.); (A.A.); (C.T.)
| |
Collapse
|
2
|
Sahiti F, Cejka V, Schmidbauer L, Albert J, Kerwagen F, Frantz S, Gelbrich G, Heuschmann PU, Störk S, Morbach C. Prognostic Utility of Pericardial Effusion in the General Population: Findings From the STAAB Cohort Study. J Am Heart Assoc 2024; 13:e035549. [PMID: 38879452 PMCID: PMC11255739 DOI: 10.1161/jaha.124.035549] [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: 03/15/2024] [Accepted: 05/14/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND The incidental finding of a pericardial effusion (PE) poses a challenge in clinical care. PE is associated with malignant conditions or severe cardiac disease but may also be observed in healthy individuals. This study explored the prevalence, determinants, course, and prognostic relevance of PE in a population-based cohort. METHODS AND RESULTS The STAAB (Characteristics and Course of Heart Failure Stages A/B and Determinants of Progression) cohort study recruited a representative sample of the population of Würzburg, aged 30 to 79 years. Participants underwent quality-controlled transthoracic echocardiography including the dedicated evaluation of the pericardial space. Of 4965 individuals included at baseline (mean age, 55±12 years; 52% women), 134 (2.7%) exhibited an incidentally diagnosed PE (median diameter, 2.7 mm; quartiles, 2.0-4.1 mm). In multivariable logistic regression, lower body mass index and higher NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels were associated with PE at baseline, whereas inflammation, malignancy, and rheumatoid disease were not. Among the 3901 participants attending the follow-up examination after a median time of 34 (30-41) months, PE was found in 60 individuals (1.5%; n=18 new PE, n=42 persistent PE). Within the follow-up period, 37 participants died and 93 participants reported a newly diagnosed malignancy. The presence of PE did not predict all-cause death or the development of new malignancy. CONCLUSIONS Incidental PE was detected in about 3% of individuals, with the vast majority measuring <10 mm and completely resolving. PE was not associated with inflammation markers, death, incident heart failure, or malignancy. Our findings corroborate the view of current guidelines that a small PE in asymptomatic individuals can be considered an innocent phenomenon and does not require extensive short-term monitoring.
Collapse
Affiliation(s)
- Floran Sahiti
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
| | - Vladimir Cejka
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
| | - Lena Schmidbauer
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Institute of Clinical Epidemiology and BiometryUniversity of WurzburgGermany
- Clinical Trial CenterUniversity Hospital and University of WurzburgGermany
| | - Judith Albert
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
| | - Fabian Kerwagen
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
| | - Stefan Frantz
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
| | - Götz Gelbrich
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Institute of Clinical Epidemiology and BiometryUniversity of WurzburgGermany
- Clinical Trial CenterUniversity Hospital and University of WurzburgGermany
| | - Peter U. Heuschmann
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Institute of Clinical Epidemiology and BiometryUniversity of WurzburgGermany
- Clinical Trial CenterUniversity Hospital and University of WurzburgGermany
- Institute of Medical Data ScienceUniversity Hospital WurzburgGermany
| | - Stefan Störk
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
| | - Caroline Morbach
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital and University of WurzburgGermany
- Department of Medicine I, Division of CardiologyUniversity Hospital of WurzburgGermany
| |
Collapse
|
3
|
Conte E, Tamanini S, Bizzi E, Maestroni S, Cumetti D, Novembre ML, Lauri G, Agalbato C, Cia AD, Paolisso P, Pontone G, Pepi M, Andreini D, Imazio M, Lazaros G, Benetti A, Brucato A. Post-cardiac injury syndrome and pericardial effusion recurrence after pericardial effusion drainage in chronic idiopathic pericardial effusion. Eur J Intern Med 2024; 123:132-137. [PMID: 38262844 DOI: 10.1016/j.ejim.2024.01.024] [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: 09/13/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
INTRODUCTION The management of even large pericardial effusions in asymptomatic patients is still a matter of debate. Aim of the present study is to explore, in a multicenter setting, the rate of post-cardiac injury syndromes (PCIS) and pericardial effusion recurrence after pericardial effusion drainage procedure. MATERIAL AND METHODS This is a multicenter international retrospective study including a consecutive cohort of patients diagnosed with large, chronic and idiopathic pericardial effusions, prospectively evaluated from January 2003 to December 2021 who underwent a clinically indicated pericardial drainage procedure. Two separate end-points were recorded: 1) recurrence of pericardial effusion after drainage without any sign of pericardial inflammation 2) occurrence of PCIS, defined as the new onset of pericarditis 1 to 6 weeks after pericardial intervention. RESULTS 124 patients were enrolled (50 % female, mean age 64 years old). A mean follow-up of 29.6 ± 25.6 months was obtained in 110 patients (88 %). 110 patients were treated with pericardiocentesis (89 %), 25 with pleuro-pericardial windows (20 %), and 1 with pericardiectomy (1 %). PCIS occurred in 21 out of 124 patients followed for at least 6 weeks (16.9%). Recurrence of pericardial effusion after drainage without any sign of pericardial inflammation occurred in 68 out of 110 patients at a longer follow-up (61.8 %). At multivariate analysis only inflammatory cells in pericardial fluid was associated with PCIS and pericardiocentesis with pericardial effusion recurrency. CONCLUSION Our data support the need of caution with the use of pericardiocentesis in asymptomatic patients with large pericardial effusion as it is often associated with pericardial effusion recurrence. Of interest the presence of inflammatory cells in the pericardial fluid is associated with PCIS after pericardial drainage procedures.
Collapse
Affiliation(s)
- Edoardo Conte
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical Science for Health, University of Milan, Milan, Italy.
| | - Silvia Tamanini
- Internal Medicine Department, Fatebenefratelli Hospital, Milan, Italy
| | - Emanuele Bizzi
- Internal Medicine Department, Fatebenefratelli Hospital, Milan, Italy
| | - Silvia Maestroni
- Internal Medicine Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Davide Cumetti
- Internal Medicine Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | | | | | | | | | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Universita' degli Studi di Milano
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Massimo Imazio
- Cardiothoracic Department, University Hospital "Santa Maria della Misericordia," ASUFC, and Department of Medicine, University of Udine, Italy
| | - George Lazaros
- Cardiology Clinic, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece
| | - Alberto Benetti
- Internal Medicine Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Antonio Brucato
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| |
Collapse
|
4
|
Akao K, Imamura T, Kinugawa K. Small Left Ventricular Size Is a Risk Factor for Recurrent Pericardial Effusion after Percutaneous Drainage. J Clin Med 2024; 13:2644. [PMID: 38731173 PMCID: PMC11084400 DOI: 10.3390/jcm13092644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Significant pericardial effusion requires percutaneous drainage. Some patients experience recurrent pericardial effusion following index drainage, but its risk factors remain unknown. Such knowledge should further improve the clinical management of individuals presenting with pericardial effusion for risk stratification and the construction of therapeutic and management strategies beforehand. Methods: Patients who underwent percutaneous drainage for pericardial effusion between 2018 and 2023 were retrospectively included and were followed for 2 years or until November 2023. Baseline factors associated with recurrent pericardial effusion that required percutaneous drainage again were investigated to identify the high-risk cohort. Results: A total of 39 patients (83 years on median, 28 males) were included. During the 2-year observation period, 11 patients had the primary outcome. The left ventricular end-diastolic diameter at baseline was independently associated with the primary outcome with an adjusted hazard ratio of 0.88 (95% confidence interval 0.80-0.97, p = 0.013) with a cutoff of 42 mm, which significantly stratified the cumulative incidence of the primary outcome (53% versus 10%, p = 0.011). Conclusions: Recurrent pericardial effusion after percutaneous drainage is not a rare phenomenon. A smaller left ventricular endo-diastolic diameter was an independent risk factor for recurrent pericardial effusion. The clinical implications of our findings in daily clinical practice should be validated in future prospective studies. Further studies are warranted to clarify the underlying causality between them.
Collapse
Affiliation(s)
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama 930-0194, Japan
| | | |
Collapse
|
5
|
Gyöngyösi M, Hasimbegovic E, Han E, Zlabinger K, Spannbauer A, Riesenhuber M, Hamzaraj K, Bergler-Klein J, Hengstenberg C, Kammerlander A, Kastl S, Loewe C, Beitzke D. Improvement of Symptoms and Cardiac Magnetic Resonance Abnormalities in Patients with Post-Acute Sequelae of SARS-CoV-2 Cardiovascular Syndrome (PASC-CVS) after Guideline-Oriented Therapy. Biomedicines 2023; 11:3312. [PMID: 38137533 PMCID: PMC10742066 DOI: 10.3390/biomedicines11123312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Cardiac magnetic resonance (CMR) studies reported CMR abnormalities in patients with mild-moderate SARS-CoV-2 infection, suggesting ongoing myocardial inflammation. Patients (n = 278, 43 ± 13 years, 70.5% female) with post-acute sequelae of SARS-CoV-2 cardiovascular syndrome (PASC-CVS) were included prospectively into the Vienna POSTCOV Registry between March 2021 and March 2023 (clinicaltrials.gov NCT05398952). Clinical, laboratory, and CMR findings were recorded. Patients with abnormal CMR results were classified into isolated chronic pericardial (with/without pleural) effusion, isolated cardiac function impairment, or both (myopericarditis) groups. Medical treatment included a nonsteroidal anti-inflammatory agent (NSAID) for pericardial effusion and a condition-adapted maximal dose of heart failure (HF) treatment. Three months after medical therapy, clinical assessment and CMR were repeated in 82 patients. Laboratory analyses revealed normal hematological, inflammatory, coagulation, and cardiac biomarkers. CMR abnormalities were found in 155 patients (55.8%). Condition-adapted HF treatment led to a significant increase in the left ventricular ejection fraction (LVEF) in patients with initially reduced LVEF (from 49 ± 5% to 56 ± 4%, p = 0.009, n = 25). Low-moderate doses of NSAIDs for 3 months significantly reduced pericardial effusion (from 4/3;5.75/mm to 2/0;3/mm, median/interquartile ranges/p < 0.001, n = 51). Clinical symptoms improved markedly with a decrease in CMR abnormalities, which might be attributed to the maintenance of NSAID and HF medical treatment for PASC-CVS.
Collapse
Affiliation(s)
- Mariann Gyöngyösi
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Ena Hasimbegovic
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Emilie Han
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Katrin Zlabinger
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Andreas Spannbauer
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Martin Riesenhuber
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Kevin Hamzaraj
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Jutta Bergler-Klein
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Christian Hengstenberg
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Andreas Kammerlander
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Stefan Kastl
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.H.); (E.H.); (K.Z.); (A.S.); (M.R.); (K.H.); (J.B.-K.); (C.H.); (A.K.); (S.K.)
| | - Christian Loewe
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (C.L.); (D.B.)
| | - Dietrich Beitzke
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria; (C.L.); (D.B.)
| |
Collapse
|
6
|
Mardigyan V, Imazio M, Brucato A, Fedak PWM, Klein AL. Unveiling the Spectrum of Pericardial Diseases: Insights, Novelties, and Future Directions. Can J Cardiol 2023; 39:1044-1046. [PMID: 37343717 DOI: 10.1016/j.cjca.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023] Open
Affiliation(s)
- Vartan Mardigyan
- Department of Medicine, Jewish General Hospital, Montréal, Québec, Canada.
| | - Massimo Imazio
- Department of Medicine, University Hospital Santa Maria della Misericordia, and University of Udine, Italy; Department of Medicine, University Hospital Santa Maria della Misericordia, and University of Udine, Italy
| | - Antonio Brucato
- Department of Biomedical and Clinical Sciences, University of Milan, Fatebenefratelli Hospital, Milan, Italy
| | - Paul W M Fedak
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|