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Eke OF, Jalbout NA, Selame L, Gullikson J, Deng H, Shokoohi H. Pericardial tamponade: a new perspective on echocardiographic features and application of a prediction score. Intern Emerg Med 2024:10.1007/s11739-024-03682-9. [PMID: 38907757 DOI: 10.1007/s11739-024-03682-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/14/2024] [Indexed: 06/24/2024]
Abstract
Few clinical decision rules have been used to guide clinical management and predict outcomes in patients with pericardial tamponade. The objectives of this study are to identify the echocardiographic features associated with adverse outcomes in patients with pericardial effusions requiring pericardiocentesis and to apply a previously described four-point clinical and echocardiographic score to predict clinical outcomes over 24-hr, 30-day, and 1-year intervals. We performed a retrospective cohort review of patients who had transthoracic echocardiogram (TTE) performed and underwent pericardiocentesis within 48 h of emergency department presentation at two large tertiary care institutions. We constructed different stepwise logistic regression models and examined the associations of TTE characteristics and clinical features with ICU admission, hospital length of stay (h-LOS), and survival. The data set was then employed against a previously proposed scoring system to predict factors associated with clinical outcomes over 24 hr, 30 days, and 1 year. Two hundred thirty-nine patients were included in the final analysis. Echocardiographic characteristics of patients with pericardial tamponade who underwent pericardiocentesis are as follows: 69.1% right ventricular (RV) diastolic collapse, 62.3% exaggerated mitral valve (MV) inflow velocities, 56.4% inferior vena cava (IVC) plethora, and 53.4% right atrial (RA) systolic collapse. Increase in systolic blood pressure and increased variation in MV inflow velocity were associated with reduced ICU admission [OR: 0.94 (CI 0.90, 0.99), 0.28 (CI 0.09, 0.89), respectively]. In addition, a history of malignancy increased the length of hospital stay by about 3.89 days (CI 1.43-6.35, p < 0.01) and prior pericardiocentesis history was associated with 4.82-day increase in hospital stay (CI 1.19-8.45, p = 0.01). In utilizing the previously published prediction score, we found no statistically significant correlation in predicting survival. RV diastolic collapse and exaggerated MV inflow velocity were the most common echocardiographic findings in patients requiring pericardiocentesis. Contrary to prior studies, exaggerated MV inflow velocity was associated with reduced ICU admission. In addition, a previously described prediction score did not correlate with decreased survival in this cohort.
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Affiliation(s)
- Onyinyechi F Eke
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.
| | - Nour Al Jalbout
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Lauren Selame
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | | | - Hao Deng
- Department of Anesthesia, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Hamid Shokoohi
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
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2
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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.
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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
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3
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Ribeiro ER, Hurtado CG, Knapp T, Maul TM, Nelson JS. Idiopathic Pericardial Effusions in Children: Workup and Final Diagnoses. Pediatr Cardiol 2024; 45:926-933. [PMID: 36576526 DOI: 10.1007/s00246-022-03083-9] [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: 09/10/2022] [Accepted: 12/18/2022] [Indexed: 12/29/2022]
Abstract
Pediatric idiopathic pericardial effusions are common and often have a prolonged clinical course. We hypothesized that these effusions have no standardized diagnostic workup, and ultimately have a final etiology not initially appreciated. To test these hypotheses, a hospital system-wide retrospective (1/1/1990-10/1/2019) cohort study of pericardial effusions in children (< 18 years) was conducted. Effusions were grouped by etiology and patients receiving an initial idiopathic diagnosis were further analyzed. Effusion size, diagnostic workup, final diagnosis, and time to resolution were abstracted. In total, 42/366 effusions were initially diagnosed as idiopathic. Workup was not standardized and included up to six laboratory tests including pericardial fluid analysis and infectious, metabolic, rheumatologic and thyroid workups. Treatment course involved 1 readmission in 24%, and > 1 readmission in 12%. Resolution of effusion occurred in 83% of patients within a median of 1 admission (range 1-4). Of those effusions initially deemed idiopathic, 12/42 (29%) were later found to have an underlying etiologic diagnosis including: autoimmune (7, 58%), neoplastic (2, 16%), infectious (2, 16%), and renal (1, 8%). Children initially diagnosed with idiopathic pericardial effusions have an underlying etiologic diagnosis 29% of the time, and a standardized workup may prevent delays in definitive diagnosis and treatment.
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Affiliation(s)
- Emily R Ribeiro
- Department of Pediatrics, Nemours Children's Hospital, 6535 Nemours Parkway, Orlando, FL, 32827, USA.
| | | | - Thomas Knapp
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Timothy M Maul
- Department of Cardiovascular Services, Nemours Children's Hospital, Orlando, FL, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer S Nelson
- University of Central Florida College of Medicine, Orlando, FL, USA
- Department of Cardiovascular Services, Nemours Children's Hospital, Orlando, FL, USA
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4
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Trivedi D, Lorenzana AM, Bronchard K, Reddy B. Spontaneous Hemorrhagic Pericardial Effusion as a Consequence of Apixaban Utilization for New-Onset Atrial Fibrillation. Cureus 2024; 16:e56510. [PMID: 38646361 PMCID: PMC11026824 DOI: 10.7759/cureus.56510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
Although anticoagulation stands as a standardized therapeutic approach for mitigating thrombotic risks in atrial fibrillation, the potential for bleeding associated with direct oral anticoagulants (DOACs) is consistently weighed in the risk/benefit analysis prior to initiating therapy for non-valvular atrial fibrillation. While the typical bleeding risks from DOACs predominantly affect the gastrointestinal system, occurrences of spontaneous hemorrhagic pericardial effusions are rare. This case presentation illustrates a patient developing spontaneous hemorrhagic pericardial effusion four days after commencing apixaban therapy and subsequent management.
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Affiliation(s)
- Dhaval Trivedi
- Internal Medicine, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, USA
| | | | - Krystyna Bronchard
- Cardiology, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, USA
| | - Bharath Reddy
- Cardiac Electrophysiology, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, USA
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5
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Lazaros G, Imazio M, Tsioufis P, Lazarou E, Vlachopoulos C, Tsioufis C. Chronic Pericardial Effusion: Causes and Management. Can J Cardiol 2023; 39:1121-1131. [PMID: 36773704 DOI: 10.1016/j.cjca.2023.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/10/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023] Open
Abstract
Chronic pericardial effusion is a common pericardial syndrome whose approach has been well standardised in recent years. The main challenge associated with this condition is the progression (sometimes unheralded) to cardiac tamponade. Pericardial effusions may present either as an isolated finding or in the context of a specific etiology including autoimmune, neoplastic, or metabolic disease. Among investigations used during diagnostic work-up, echocardiography is of paramount importance for the diagnosis, sizing, and serial evaluation of the hemodynamic impact of effusions on heart diastolic function. In an individualised manner, advanced imaging including computed tomography and cardiac magnetic resonance imaging should be performed, especially if baseline tests are inconclusive. Triage of these patients according to the most recent 2015 European Society of Cardiology Guidelines for the diagnosis and management of pericardial diseases should take into account the presence of hemodynamic compromise as well as suspicion of malignant or purulent pericarditis as first step, C-reactive protein serum level measurement as second step, investigations for a specific condition known to be associated with pericardial effusion as third step, and finally the size and the duration of the effusion. Treatment depends on the evaluation of the above-mentioned parameters and should ideally be tailored to the individual patient. Prognosis of chronic pericardial effusions depends largely on the underlying etiology. According to novel data, the prognosis of individuals with idiopathic, chronic (> 3 months), large (> 2 cm), asymptomatic pericardial effusions is usually benign and a watchful waiting strategy seems more reasonable and cost-effective than routine drainage as previously recommended.
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Affiliation(s)
- George Lazaros
- First Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", ASUFC, Udine, Italy
| | - Panagiotis Tsioufis
- First Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Emilia Lazarou
- First Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Vlachopoulos
- First Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Reddy P, Kane GC, Oh JK, Luis SA. The Evolving Etiologic and Epidemiologic Portrait of Pericardial Disease. Can J Cardiol 2023; 39:1047-1058. [PMID: 37217161 DOI: 10.1016/j.cjca.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 05/24/2023] Open
Abstract
Pericardial disease includes a variety of conditions, including inflammatory pericarditis, pericardial effusions, constrictive pericarditis, pericardial cysts, and primary and secondary pericardial neoplasms. The true incidence of this varied condition is not well established, and the causes vary greatly across the world. This review aims to describe the changing pattern of epidemiology of pericardial disease and to provide an overview of causative etiologies. Idiopathic pericarditis (assumed most often to be viral) remains the most common etiology for pericardial disease globally, with tuberculous pericarditis being most common in developing countries. Other important etiologies include fungal, autoimmune, autoinflammatory, neoplastic (both benign and malignant), immunotherapy-related, radiation therapy-induced, metabolic, postcardiac injury, postoperative, and postprocedural causes. Improved understanding of the immune pathophysiological pathways has led to identification and reclassification of some idiopathic pericarditis cases into autoinflammatory etiologies, including immunoglobulin G (IgG)4-related pericarditis, tumour necrosis factor receptor-associated periodic syndrome (TRAPS), and familial Mediterranean fever in the current era. Contemporary advances in percutaneous cardiac interventions and the recent COVID-19 pandemic have also resulted in changes in the epidemiology of pericardial diseases. Further research is needed to improve our understanding of the etiologies of pericarditis, using the assistance of contemporary advanced imaging techniques and laboratory testing. Careful consideration of the range of potential causes and local epidemiologic patterns of causality are important for the optimization of diagnostic and therapeutic approaches.
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Affiliation(s)
- Prajwal Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sushil Allen Luis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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7
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Bothwell KD, Ling FS, Ambrosini R, Baran TM, Lorca MC, Chaturvedi A. Standardized Criteria for Identification of Cardiac Tamponade on Non-Electrocardiogram-gated Computed Tomography: Correlation With Echocardiographic Findings. J Thorac Imaging 2023; 38:W44-W51. [PMID: 36546839 DOI: 10.1097/rti.0000000000000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To identify imaging parameters that can help in the diagnosis of cardiac tamponade on non-electrocardiogram (ECG)-gated computed tomography (CT) of the chest. MATERIALS AND METHODS Retrospective analysis of 64 patients who had undergone CT and echocardiography for evaluation of cardiac tamponade. Of 64 patients, 34 were diagnosed with tamponade and underwent pericardiocentesis for further diagnosis and treatment. CT measurements obtained were: pericardial effusion (PeEff) pocket size in 6 locations (anterior, posterior, superior, inferior, right, and left lateral), pericardial thickening, diameters of the coronary sinus, upper superior vena cava, lower superior vena cava, and inferior vena cava. In addition, cardiac chamber sizes were measured. Subjective assessment of coronary sinus compression, pericardial enhancement, and pericardial thickening were also recorded. RESULTS Measurement of the sum of the right lateral and left lateral PeEff thickness resulted in 91.2% sensitivity and 86.7% specificity for cardiac tamponade with a threshold of 30 mm (receiver-operating characteristic area under the curve=0.94 [0.84 to 0.98], P <0.0001). Using the combination of inferior PeEff >16 mm, sum of right lateral and left lateral PeEff>30 mm, and presence of pericardial thickening resulted in 56% sensitivity and 100% specificity and positive predictive value for the determination of cardiac tamponade. CONCLUSIONS Our study suggests that CT measurements related to PeEff size and thickness aid in the diagnosis of cardiac tamponade.
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Affiliation(s)
| | - Frederick S Ling
- Medicine, Cardiology, University of Rochester Medical Center, Rochester, NY
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8
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Karasu BB, Akin B. Can Asthma Cause Pericardial Effusion? Insights Into an Intriguing Association. Tex Heart Inst J 2023; 50:491986. [PMID: 37011363 PMCID: PMC10178645 DOI: 10.14503/thij-22-7867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
BACKGROUND Pericardial effusion (PE) is a commonly encountered condition in clinical practice, but its etiology can be difficult to identify, with many cases remaining classified as idiopathic. This study aimed to investigate whether an association exists between asthma and idiopathic PE (IPE). METHODS Patients who had been diagnosed with PE in the authors' outpatient cardiology clinics between March 2015 and November 2018 were retrospectively analyzed. The study population was divided into 2 groups-non-IPE (NIPE) and IPE-based on whether a cause had been identified. Demographic, laboratory, and clinical data for the 2 groups were examined statistically. RESULTS A total of 714 patients were enrolled in the study after exclusion of 40 cases. Of these 714 patients, 558 were allocated to the NIPE group and 156 to the IPE group (NIPE group median [IQR] age, 50 [41-58] years vs IPE group median [IQR] age, 47 [39-56] years; P = .03). Asthma was significantly more prevalent among patients in the IPE group than among those in the NIPE group (n = 54 [34.6%] vs n = 82 [14.7%]; P < .001). In multivariate logistic regression analysis, asthma (odds ratio, 2.67 [95% CI, 1.53-4.67]; P = .001) was found to be an independent predictor of IPE. In the IPE group, patients with asthma had either mild or moderate PE, with the right atrium being the most common location in these patients. CONCLUSION Asthma was an independent predictor of mild to moderate IPE. The right atrium was the most frequently encountered location for PE in patients with asthma.
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Affiliation(s)
- Betul Banu Karasu
- Department of Cardiology, Etimesgut Sehit Sait Erturk State Hospital, Ankara, Turkey
| | - Berna Akin
- Department of Chest Diseases, Ankara Pursaklar State Hospital, Ankara, Turkey
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9
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Singh P, Singhal T, Shrestha J, Narayan M. Lymphoscintigraphy in idiopathic recurrent chylopericardium. BMJ Case Rep 2023; 16:e248088. [PMID: 36720510 PMCID: PMC9890820 DOI: 10.1136/bcr-2021-248088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Chylopericardium is a clinical condition due to the accumulation of triglyceride-rich chylous fluid within the pericardial space. It may be primary (idiopathic), without any apparent cause or secondary to some precipitating factors, such as cardiac surgery, malignancy, trauma, infection and radiation. Primary chylopericardium is rare and a diagnosis of exclusion, so far less than 150 cases have been reported in the literature. The authors present a case of recurrent primary chylopericardium diagnosed by lymphoscintigraphy.
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Affiliation(s)
- Parneet Singh
- Nuclear Medicine & Molecular Imaging, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
| | - Tejasvini Singhal
- Nuclear Medicine & Molecular Imaging, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
| | - Jeevan Shrestha
- Nuclear Medicine & Molecular Imaging, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
| | - Manishi Narayan
- Nuclear Medicine & Molecular Imaging, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
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10
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Deser SB, Arapi B. Evaluation of etiology of pericardial effusion in 81 patients who underwent pericardiostomy or pericardial window. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2023. [DOI: 10.29333/jcei/12605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
<b>Introduction: </b>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.<br />
<b>Materials and methods: </b>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.<br />
<b>Results: </b>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.<br />
<b>Conclusion: </b>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.
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Affiliation(s)
- Serkan Burc Deser
- Department of Cardiovascular Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Berk Arapi
- Department of Cardiovascular Surgery, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
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11
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Ohte N, Ishizu T, Izumi C, Itoh H, Iwanaga S, Okura H, Otsuji Y, Sakata Y, Shibata T, Shinke T, Seo Y, Daimon M, Takeuchi M, Tanabe K, Nakatani S, Nii M, Nishigami K, Hozumi T, Yasukochi S, Yamada H, Yamamoto K, Izumo M, Inoue K, Iwano H, Okada A, Kataoka A, Kaji S, Kusunose K, Goda A, Takeda Y, Tanaka H, Dohi K, Hamaguchi H, Fukuta H, Yamada S, Watanabe N, Akaishi M, Akasaka T, Kimura T, Kosuge M, Masuyama T. JCS 2021 Guideline on the Clinical Application of Echocardiography. Circ J 2022; 86:2045-2119. [DOI: 10.1253/circj.cj-22-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Nobuyuki Ohte
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | | | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroshi Itoh
- Department of Cardiovascular Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Science
| | - Shiro Iwanaga
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masao Daimon
- The Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health
| | - Kazuaki Tanabe
- The Fourth Department of Internal Medicine, Shimane University Faculty of Medicine
| | | | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital
| | - Kazuhiro Nishigami
- Division of Cardiovascular Medicine, Miyuki Hospital LTAC Heart Failure Center
| | - Takeshi Hozumi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Satoshi Yasukochi
- Department of Pediatric Cardiology, Heart Center, Nagano Children’s Hospital
| | - Hirotsugu Yamada
- Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | | | - Atsushi Okada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Akiko Goda
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine
| | - Yasuharu Takeda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | | | - Hidekatsu Fukuta
- Core Laboratory, Nagoya City University Graduate School of Medical Sciences
| | - Satoshi Yamada
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | | | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takeshi Kimura
- Department of Cardiology, Kyoto University Graduate School of Medicine
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
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Oh NA, Hennecken C, Van den Eynde J, Doulamis IP, Avgerinos DV, Kampaktsis PN. Pericardiectomy and Pericardial Window for the Treatment of Pericardial Disease in the Contemporary Era. Curr Cardiol Rep 2022; 24:1619-1631. [PMID: 36029363 DOI: 10.1007/s11886-022-01773-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW To summarize the contemporary practice of pericardiectomy and pericardial window. We discuss the indications, preoperative planning, procedural aspects, postprocedural management, and outcomes of each procedure. RECENT FINDINGS Surgical approaches for the treatment of pericardial disease have been around even before the emergence of cardiopulmonary bypass. Since the forthcoming of cardiopulmonary bypass, there have been significant changes in the epidemiology and diagnostic approach of pericardial diseases as well as advancements in the surgical techniques and perioperative management used in the care of these patients. Pericardiectomy has an average mortality of almost 7% and is typically performed in patients with advanced symptoms from constrictive pericarditis and relatively few comorbidities. Pericardial window is a safe procedure for the treatment of pericardial effusion that can be performed with different approaches.
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Affiliation(s)
- Nicholas A Oh
- Department of Cardiothoracic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Carolyn Hennecken
- Division of Cardiology, New York Presbyterian Hospital, Columbia University Irving Medical Center, 177 Fort Washington Av, New York, NY, 10032, USA
| | - Jef Van den Eynde
- The Johns Hopkins Hospital and School of Medicine, Helen B. Taussig Heart Center, Baltimore, MD, USA
- Department of Cardiovascular Sciences, KU Leuven, Louvain, Belgium
| | - Ilias P Doulamis
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dimitrios V Avgerinos
- Third Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Polydoros N Kampaktsis
- Division of Cardiology, New York Presbyterian Hospital, Columbia University Irving Medical Center, 177 Fort Washington Av, New York, NY, 10032, USA.
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Emorinken A, Dic-Ijiewere MO, Izirein HO. Cardiac Tamponade, an Unusual First Presentation of Systemic Lupus Erythematosus: A Case Report in a Rural Tertiary Hospital. Cureus 2022; 14:e27989. [PMID: 36120196 PMCID: PMC9469684 DOI: 10.7759/cureus.27989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 11/05/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a condition that manifests in a variety of ways. Although pericarditis and pericardial effusion are frequent cardiac manifestations of SLE, cardiac tamponade is rarely reported, especially as the initial manifestation of the disease. We describe a 38-year-old Nigerian lady who presented with three months of progressive dyspnea. She had intermittent fever, tachycardia, tachypnea, hypotension, jugular vein distension, and muffled heart sounds. Echocardiography confirmed cardiac tamponade. The ANA, anti-dsDNA, and anti-Sm antibodies were positive. She had a high ESR and low levels of blood complements. The diagnosis of SLE was established based on the 2019 EULAR/ACR classification criteria. She was treated with intravenous methylprednisolone, oral prednisolone, and hydroxychloroquine after undergoing an emergency echo-guided pericardiocentesis. She responded well to treatment, and she is currently being followed up on an outpatient basis. Clinicians should consider SLE as a differential when evaluating patients with pericardial effusion, as an accurate and timely diagnosis could be lifesaving.
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Masaru I, Tetsuya K, Hisashi S. Pericardioperitoneal shunt for the treatment of refractory non-malignant pericardial effusion. Interact Cardiovasc Thorac Surg 2022; 35:6673149. [PMID: 35993889 PMCID: PMC9415194 DOI: 10.1093/icvts/ivac215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/18/2022] [Accepted: 08/19/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
We report the case of a 74-year-old man treated for refractory non-malignant pericardial effusion using a pericardioperitoneal shunt. After the failure of conventional pericardiocentesis, a pericardioperitoneal shunt using a Denver shunt was inserted to drain the pericardial effusion into the peritoneal cavity. At 3-year follow-up, the effusion was well controlled and the shunt remained patent.
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Affiliation(s)
- Ishida Masaru
- Department of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital , Takarazuka, Japan
| | - Kajiyama Tetsuya
- Department of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital , Takarazuka, Japan
| | - Satoh Hisashi
- Department of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital , Takarazuka, Japan
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15
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Ji D, Wu Z, Dai H, Yang J, Zhang X, Jin J, Li Q, Yao H. Perioperative Complications and Postoperative Mortality in Patients of Acute Stanford Type a Aortic Dissection with Cardiac Tamponade. J INVEST SURG 2022; 35:1536-1543. [PMID: 35635013 DOI: 10.1080/08941939.2022.2078022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Dong Ji
- Department of Anesthesiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Ziyi Wu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Hongyu Dai
- Department of Anesthesiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Jing Yang
- Department of Anesthesiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xun Zhang
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Jing Jin
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Qingguo Li
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Hao Yao
- Department of Anesthesiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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Lazaros G, Lazarou E, Tsioufis P, Soulaidopoulos S, Iliakis P, Vlachopoulos C, Tsioufis C. Chronic pericardial effusion: current concepts and emerging trends. Expert Rev Cardiovasc Ther 2022; 20:363-376. [PMID: 35524164 DOI: 10.1080/14779072.2022.2075346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Pericardial effusion (PEF) is a common and challenging pericardial syndrome with a variety of clinical manifestations ranging from asymptomatic, incidentally uncovered small PEFs, to life-threatening cardiac tamponade. AREAS COVERED : This review focuses on the pathophysiology, epidemiology, etiology, classification, clinical findings, diagnostic work-up, management and outcome of PEFs. Particular emphasis has been given on the most recent evidence concerning the contribution of imaging for the detection, differential diagnosis and evaluation of the hemodynamic impact of PEFs on the diastolic filling of the heart. Moreover, simplified algorithms for PEF triage and management have been included. EXPERT OPINION The management of patients with PEFs is mainly based on four parameters namely hemodynamic impact on diastolic function, elevation of inflammatory markers, presence of a specific underlying condition known to be associated with PEF and finally size and duration of the effusion. Novel data have contributed to change our view towards large, asymptomatic, "idiopathic" PEFs and dictated a rather conservative approach in most cases. It is also stressed that there is a compelling need for additional research, which is essential for tailored treatments aiming at the improvement of quality of life and containment of health care costs.
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Affiliation(s)
- George Lazaros
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Emilia Lazarou
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Panagiotis Tsioufis
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Panagιotis Iliakis
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Charalambos Vlachopoulos
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
| | - Costas Tsioufis
- First Department of Cardiology, "Hippokration" Hospital, University of Athens Medical School, Athens, Greece
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Alerhand S, Adrian RJ, Long B, Avila J. Pericardial tamponade: A comprehensive emergency medicine and echocardiography review. Am J Emerg Med 2022; 58:159-174. [DOI: 10.1016/j.ajem.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/03/2022] [Indexed: 10/18/2022] Open
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Rafaniello C, Gaio M, Zinzi A, Sullo MG, Liguori V, Ferraro M, Petronzelli F, Felicetti P, Marchione P, Marra AR, Rossi F, De Angelis A, Capuano A. Disentangling a Thorny Issue: Myocarditis and Pericarditis Post COVID-19 and Following mRNA COVID-19 Vaccines. Pharmaceuticals (Basel) 2022; 15:ph15050525. [PMID: 35631352 PMCID: PMC9145505 DOI: 10.3390/ph15050525] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/20/2022] [Accepted: 04/23/2022] [Indexed: 12/31/2022] Open
Abstract
Considering the clinical significance for myocarditis and pericarditis after immunization with mRNA COVID-19 vaccines, the present pharmacovigilance study aimed to describe these events reported with mRNA COVID-19 vaccines in the Vaccine Adverse Events Reporting System (VAERS). From 1990 to July 2021, the mRNA vaccines were the most common suspected vaccines related to suspected cases of myocarditis and/or pericarditis (myocarditis: N = 1,165; 64.0%; pericarditis: N = 743; 55.1%), followed by smallpox vaccines (myocarditis: N = 222; 12.2%; pericarditis: N = 200; 14.8%). We assessed all suspected cases through the case definition and classification of the Brighton Collaboration Group, and only definitive, probable, and possible cases were included in the analysis. Our findings suggested that myocarditis and pericarditis mostly involve young male, especially after the second dose with a brief time to onset. Nevertheless, this risk is lower (0.38/100,000 vaccinated people; 95% CI 0.36–0.40) than the risk of developing myocarditis after SARS-CoV-2 infection (1000–4000 per 100,000 people) and the risk of developing “common” viral myocarditis (1–10 per 100,000 people/year). Comparing with the smallpox vaccine, for which is already well known the association with myocarditis and pericarditis, our analysis showed a lower probability of reporting myocarditis (ROR 0.12, 95% CI 0.10–0.14) and pericarditis (ROR 0.06, 95% CI 0.05–0.08) following immunization with mRNA COVID-19 vaccines.
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Affiliation(s)
- Concetta Rafaniello
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (C.R.); (M.G.); (M.G.S.); (V.L.); (M.F.); (F.R.); (A.C.)
- Section of Pharmacology “L. Donatelli”, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Mario Gaio
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (C.R.); (M.G.); (M.G.S.); (V.L.); (M.F.); (F.R.); (A.C.)
- Section of Pharmacology “L. Donatelli”, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Alessia Zinzi
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (C.R.); (M.G.); (M.G.S.); (V.L.); (M.F.); (F.R.); (A.C.)
- Section of Pharmacology “L. Donatelli”, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
- Correspondence:
| | - Maria Giuseppa Sullo
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (C.R.); (M.G.); (M.G.S.); (V.L.); (M.F.); (F.R.); (A.C.)
- Section of Pharmacology “L. Donatelli”, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Valerio Liguori
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (C.R.); (M.G.); (M.G.S.); (V.L.); (M.F.); (F.R.); (A.C.)
- Section of Pharmacology “L. Donatelli”, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Marialuisa Ferraro
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (C.R.); (M.G.); (M.G.S.); (V.L.); (M.F.); (F.R.); (A.C.)
- Section of Pharmacology “L. Donatelli”, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Fiorella Petronzelli
- Pharmacovigilance Unit, Post-Marketing Surveillance Area, Italian Medicine Agency, 00187 Rome, Italy;
| | - Patrizia Felicetti
- Post-Marketing Surveillance Area, Italian Medicine Agency, 00187 Rome, Italy; (P.F.); (A.R.M.)
| | - Pasquale Marchione
- Signal Management Unit, Post-Marketing Surveillance Area, Italian Medicine Agency, 00187 Rome, Italy;
| | - Anna Rosa Marra
- Post-Marketing Surveillance Area, Italian Medicine Agency, 00187 Rome, Italy; (P.F.); (A.R.M.)
| | - Francesco Rossi
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (C.R.); (M.G.); (M.G.S.); (V.L.); (M.F.); (F.R.); (A.C.)
- Section of Pharmacology “L. Donatelli”, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Antonella De Angelis
- Section of Pharmacology “L. Donatelli”, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (C.R.); (M.G.); (M.G.S.); (V.L.); (M.F.); (F.R.); (A.C.)
- Section of Pharmacology “L. Donatelli”, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
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Zhao B, Zhang J, Li Y, Feng X, Mao S, Yin Z, Liu L, Song D, Wang S. Prevalence, Predictors, and Clinical Presentation of Acute Pericardial Effusion Following Percutaneous Coronary Intervention. Front Cardiovasc Med 2022; 8:759164. [PMID: 35087880 PMCID: PMC8787085 DOI: 10.3389/fcvm.2021.759164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Iatrogenic pericardial effusion (PE) has been demonstrated to lead to cardiac injury as a sign of systemic inflammatory response. Objectives: This study sought to determine the anatomical characteristics and clinical presentation associated with PE after percutaneous coronary intervention (PCI) by using echocardiography. Methods: The clinical outcomes of all patients with coronary artery disease who underwent PCI from July 2014 to December 2018 were evaluated. The quantitative and qualitative analyses of PE were performed. The associations between the presence of PE and procedural factors were also evaluated. Results: A total of 882 patients were enrolled. PE was found in 144 patients (16.3%) and was mostly located in the anterior pericardium at low amounts. The serum levels of high-sensitive C-reaction protein before PCI and troponin T in the group with PE after PCI were significantly higher than those in the group without PE (p < 0.0001). The presence of PE was associated with the procedural time (OR = 1.02, p = 0.035) and the degree of interventional complexity (multiple vessels OR = 1.89, p = 0.014; chronic total occlusion OR = 2.04, p = 0.005; and PCI with rotational atherectomy OR = 1.15, p = 0.011) independent of the number of culprit vessels and stents. During 1-year follow-up, a significantly higher number of cardiac deaths (3) and myocardial infarctions (8) occurred in patients with PE than in patients without PE (P < 0.05). Conclusion: Post-PCI acute PE was frequent, generally mild, mainly asymptomatic, and independently associated with procedural time and complexity. This effusion, which is considered as a cardiac damage marker, could be a predominant clinical sign for long-term prognosis.
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Affiliation(s)
- Bei Zhao
- Department of Cardiology, People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Jie Zhang
- Department of Cardiology, People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Yun Li
- Outpatient Department, The 22nd Retirement Home for Resigning Cadres in Haidian District, Beijing Garrison of People's Liberation Army, Beijing, China
| | - Xueyao Feng
- Department of Cardiology, People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Shuai Mao
- Department of Cardiology, People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Zhao Yin
- Department of Cardiology, People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Li Liu
- Department of Cardiology, People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Dapeng Song
- Department of Cardiology, People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Shouli Wang
- Department of Cardiology, People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, China
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Song MJ, Jo U, Jeong JS, Cho KJ, Gong G, Cho YM, Song JS. Clinico-cytopathologic analysis of 574 Pericardial Effusion Specimens: Application of the international system for reporting serous fluid cytopathology (ISRSFC) and long-term clinical follow-up. Cancer Med 2021; 10:8899-8908. [PMID: 34747147 PMCID: PMC8683522 DOI: 10.1002/cam4.4408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/22/2021] [Accepted: 10/25/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION A pericardial effusion (PE) has a variable etiology and the primary role is diagnosis of metastatic malignancy. We analyzed the PE cytology in a large cohort in accordance with the international system for reporting serous fluid cytopathology (ISRSFC) and evaluated the long-term patient outcomes. METHODS PE specimens from 2010 to 2014 with an available clinical history, cytologic data, and pericardial biopsy results were collected. RESULTS A total of 574 PE specimens were obtained from 486 patients, representing 1.5% (574/38,589) of all body fluid specimens. Three hundred and eighty-two (66.6%) cases were "negative," 54 (9.4%) cases were "atypia of undetermined significance," 10 (1.7%) cases were "suspicious for malignancy," and 128 (22.3%) cases were "malignancy". The most common origin for malignant PE was the lung (82.1%), in both men (70.5%) and women (50.6%). Breast cancer (20%) in women and gastric cancer (4.9%) in men were the second most common malignant PE, respectively. The mean interval from the occurrence of malignant PE to death was 10.06 months (range; 0-116.03 months, median 3.5 months), and the 1-year survival rate was 16.7%. In addition, the 1-year survival rates after malignant PE onset were 0% for gastric cancer, 13.9% for lung cancer, 19.8% for breast cancer, and 21.1% for the other cancers (p = 0.011). CONCLUSION Our present study is the first to our knowledge to classify the pericardial fluid from 574 cases in accordance with the recently published ISRSFC, and to present the long-term outcomes of patients with malignant PE at the same time. Moreover, we report for the first time that it is gastric and not lung cancer patients that have the poorest prognosis after the occurrence of malignant PE.
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Affiliation(s)
- Min Jeong Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Uiree Jo
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Seon Jeong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Ja Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gyungyub Gong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Mee Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Seon Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
Purpose of Review Pericardial effusion is a challenging pericardial syndrome and a cause of serious concern for physicians and patients due to its potential progression to life-threatening cardiac tamponade. In this review, we summarize the contemporary evidence of the etiology; diagnostic work-up, with particular emphasis on the contribution of multimodality imaging; therapeutic options; and short- and long-term outcomes of these patients. Recent Findings In recent years, an important piece of information has contributed to put together several missing parts of the puzzle of pericardial effusion. The most recent 2015 guidelines of the European Society of Cardiology for the diagnosis and management of pericardial diseases are a valuable aid for a tailored approach to this condition. Actually, current guidelines suggest a 4-step treatment algorithm depending on the presence or absence of hemodynamic impairment; the elevation of inflammatory markers; the presence of a known or first-diagnosed underlying condition, possibly related to pericardial effusion; and finally the duration and size of the effusion. In contrast to earlier perceptions, based on the most recent evidence, it seems that in the subgroup of asymptomatic patients with large (> 2-cm end-diastolic diameter), chronic (> 3 months) C-reactive protein negative, idiopathic (without an apparent cause) pericardial effusion, a conservative approach is the most reasonable option. Summary At present there is an increasing interest in the pericardial syndromes in general and pericardial effusions in specific, which has consistently expanded our knowledge in this “hazy landscape.” Apart from general recommendations applied to all cases, an individualized, etiologically driven treatment is of paramount importance.
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Affiliation(s)
- George Lazaros
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11528 Athens, Greece
| | - Charalambos Vlachopoulos
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11528 Athens, Greece
| | - Emilia Lazarou
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11528 Athens, Greece
| | - Konstantinos Tsioufis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11528 Athens, Greece
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Imazio M, De Ferrari GM. Cardiac tamponade: an educational review. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2021; 10:102–109. [PMID: 32628038 DOI: 10.1177/2048872620939341] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 06/15/2020] [Indexed: 01/03/2023]
Abstract
Cardiac tamponade is a pericardial syndrome characterised by an impairment of the diastolic filling of the ventricles causing reduction of cardiac output, usually producing signs and symptoms of cardiac arrest, if untreated. The main causes of cardiac tamponade include percutaneous cardiac interventions, malignacies, infectious/inflammatory causes, mechanical complications of myocardial infarction and aortic dissection. The diagnosis of cardiac tamponade is a clinical diagnosis based on a suggestive history and clinical presentation with worsening dyspnoea, distended jugular veins, muffled heart sounds and pulsus paradoxus, and should be confirmed by echocardiography. Cardiac tamponade is a life-threatening syndrome that requires urgent treatment by pericardiocentesis. Pericardiocentesis is an interventional technique to drain pericardial fluid by a percutaneous route. The standard technique for pericardiocentesis is guided by echocardiography or fluoroscopy under local anaesthesia. Pericardiocentesis should be performed by experienced operators and carries a variable risk of complications, mainly cardiac chamber puncture, arrhythmias (ventricular arrhythmias suggest puncture of the ventricle), coronary artery puncture or haemothorax, pneumothorax, pneumopericardium and hepatic injury. The prognosis of cardiac tamponade is essentially related to aetiology. Cardiac tamponade in patients with cancer and metastatic involvement of the pericardium has a bad short-term prognosis because it is a sign of advanced cancer, on the contrary, patients with cardiac tamponade and a final diagnosis of idiopathic pericarditis generally have a good long-term prognosis.
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Affiliation(s)
- Massimo Imazio
- University Cardiology, AOU Città della Salute e della Scienza di Torino, Italy
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23
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Lazaros G, Antonopoulos AS, Lazarou E, Vlachopoulos C, Vogiatzi G, Vassilopoulos D, Tousoulis D. Age- and sex-based differences in patients with acute pericarditis. Eur J Clin Invest 2021; 51:e13392. [PMID: 32857868 DOI: 10.1111/eci.13392] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Acute pericarditis has a wide spectrum of clinical presentations largely depending on underlying aetiologies. We assessed the role of age and sex in the clinical features and outcome of acute pericarditis. MATERIALS AND METHODS A total of 240 consecutive patients hospitalized with a first episode of acute pericarditis were included. At baseline demographics, clinical features, laboratory and imaging findings and medical therapy were recorded. Patients were followed up for at least 18 months for complications. Data comparisons were performed according to sex and age (≤60 or >60 years). RESULTS The male/female ratio was 1.42, and 56% of patients were >60 years. Younger patients depicted more often chest pain (P = .001), fever and rubs (P < .001 for both), ST elevation and PR depression (P = .032 and .009, respectively), higher CRP values (P = .009) and less often dyspnoea (P = .046) and pericardial effusion (P = .036). Moreover, they received less often glucocorticoids (P < .001) and depicted less atrial fibrillation (P = .003) and a higher rate of recurrent pericarditis (P = .013). After multivariate adjustment for confounders, age >60 years remained an independent predictor for a lower risk of recurrent pericarditis (hazard ratio 0.60, 95% CI: 0.39-0.96, P = .033). Regarding sex, females were older (P = .007), showed less often ST elevation and PR depression (P < .001 and .002, respectively) and had a higher baseline heart rate (P = .02). Sex was not associated with recurrent pericarditis risk. CONCLUSIONS Patients with acute pericarditis have distinct presenting clinical, biochemical and prognostic features according to age and sex. Awareness of such differences is important for clinical decision-making.
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Affiliation(s)
- George Lazaros
- 1st Cardiology Clinic, School of Medicine, Hippokration General Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexios S Antonopoulos
- 1st Cardiology Clinic, School of Medicine, Hippokration General Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Emilia Lazarou
- 1st Cardiology Clinic, School of Medicine, Hippokration General Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Vlachopoulos
- 1st Cardiology Clinic, School of Medicine, Hippokration General Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Vogiatzi
- 1st Cardiology Clinic, School of Medicine, Hippokration General Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vassilopoulos
- 2nd Department of Medicine and Laboratory, Clinhical Immunology-Rheumatology Unit, School of Medicine, Hippokration General Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tousoulis
- 1st Cardiology Clinic, School of Medicine, Hippokration General Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
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Lazaros G, Vlachopoulos C, Lazarou E, Tousoulis D, Tsioufis C. Contemporary management of pericardial effusion. Panminerva Med 2021; 63:288-300. [PMID: 33393752 DOI: 10.23736/s0031-0808.20.04197-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pericardial effusion is a relatively common clinical condition with a variety of clinical manifestations ranging from incidentally discovered asymptomatic cases to life-threatening cardiac tamponade. The etiology encompasses idiopathic cases and forms secondary to different conditions, including autoimmune diseases, malignancies, metabolic disorders, etc. While medical therapy should be offered to patients with elevation of inflammatory markers, in specific forms treatment should be appropriate to the underlying disorder. In cases with hemodynamic compromise pericardial drainage either with pericardiocentesis or pericardial "window" is indicated for therapeutic and diagnostic purposes. In the remainder, factors like comorbidities, size and location of the pericardial effusion will influence the clinical decision making. In asymptomatic or minimally symptomatic chronic large idiopathic pericardial effusions, according to recent evidence, a conservative approach with watchful waiting seems the most reasonable option. The prognosis of pericardial effusions largely depends on the underlying etiologies. Metastatic spread to the pericardium has an ominous prognosis whereas large to moderate effusions have been often associated with known or newly discovered specific underlying causes. Chronic small idiopathic effusions have an excellent prognosis and do not require specific monitoring. Large chronic idiopathic effusions in clinically stable patients require a 3 to 6-month assessment ideally in a specialized unit.
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Affiliation(s)
- George Lazaros
- First Cardiology Clinic, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece -
| | - Charalambos Vlachopoulos
- First Cardiology Clinic, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Emilia Lazarou
- First Cardiology Clinic, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tousoulis
- First Cardiology Clinic, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantinos Tsioufis
- First Cardiology Clinic, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Boldan A, Negru AG, Boldan M, Mazilu L, Tudor A, Popovici D, Săftescu S, Luca CT, Negru ȘM. Neoplasia-Associated Pericarditis-Predictor of Cancer Progression? Diagnostics (Basel) 2021; 11:diagnostics11010058. [PMID: 33401692 PMCID: PMC7823862 DOI: 10.3390/diagnostics11010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/06/2020] [Accepted: 12/30/2020] [Indexed: 11/16/2022] Open
Abstract
Pericarditis may signal the presence of cancer, even in the absence of other clinical or paraclinical signs. Corollary, the following question arises: Could the discovery of a newly developed pericarditis be used in patients with known neoplasia as a marker of cancer progression? In an attempt to find an answer to this question, this two-centre study included 341 consecutive patients with a confirmed diagnosis of cancer and evidence of pericardial effusion at echocardiography and/or CT/MRI scan. The patients' data were collected retrospectively if they further fulfilled the following inclusion criteria: available medical data from confirmation of pericarditis until evidence of cancer progression or until at least 12 months without progression. The average age of the patients was 62.16 years (22-86 years), and the study comprised 44.28% males and 55.71% females. All types of the most common neoplasms were represented. The results showed that 85.33% of patients had cancer progression temporally linked to pericarditis. Of these, 41.64% had cancer progression within 18 months after the diagnosis of pericarditis with a median time to progression of 5.03 months, ranging from 0 to 17 months; 43.69% had progression within a maximum of 2 months before the diagnosis of pericarditis. Only 14.66% had no cancer progression during the observation period. We concluded that pericarditis could be a sensitive marker of cancer evolution that could be widely used as a follow-up investigation for cancer patients as a marker of progression or recidive.
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Affiliation(s)
- Anca Boldan
- Oncomed Oncology Outpatient Clinic, 300239 Timișoara, Romania;
| | - Alina Gabriela Negru
- Department of Cardiology, University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Correspondence: (A.G.N.); (C.T.L.); Tel.: +40-746239777 (A.G.N.)
| | - Maria Boldan
- University of Medicine and Pharmacy Timișoara Student, 300041 Timișoara, Romania;
| | - Laura Mazilu
- Department of Oncology, Faculty of Medicine, Ovidius University of Constanta, 900470 Constanța, Romania;
| | - Anca Tudor
- Discipline of Computer Science and Medical Biostatistics, University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Dorel Popovici
- Department of Oncology, University of Medicine and Pharmacy “Victor Babeș”, 300041 Timișoara, Romania; (D.P.); (S.S.); (Ș.M.N.)
| | - Sorin Săftescu
- Department of Oncology, University of Medicine and Pharmacy “Victor Babeș”, 300041 Timișoara, Romania; (D.P.); (S.S.); (Ș.M.N.)
| | - Constantin Tudor Luca
- Department of Cardiology, University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Correspondence: (A.G.N.); (C.T.L.); Tel.: +40-746239777 (A.G.N.)
| | - Șerban Mircea Negru
- Department of Oncology, University of Medicine and Pharmacy “Victor Babeș”, 300041 Timișoara, Romania; (D.P.); (S.S.); (Ș.M.N.)
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Harsten R, Kelly M, Garner M, Roberts P. Rare complication after pericardial window: symptomatic diaphragmatic hernia containing bowel and liver. BMJ Case Rep 2020; 13:13/11/e236078. [PMID: 33257358 DOI: 10.1136/bcr-2020-236078] [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] [Indexed: 11/04/2022] Open
Abstract
A 37-year-old woman presented to her local district general hospital with a cough, pleuritic chest pain and intermittent cyanosis. Eight months prior, she underwent a successful pericardial window for recurrent, symptomatic pericardial effusions. On presentation she was hypoxic but haemodynamically stable. Her chest radiograph raised the suspicion of a diaphragmatic hernia, confirmed by CT imaging. This identified herniation through the diaphragm of the transverse colon and left lobe of the liver resulting in cardiac compression and right ventricular dysfunction. She continued to deteriorate and required emergency intubation to allow safe transfer to a tertiary upper gastrointestinal unit. She underwent a laparotomy and repair of the diaphragmatic hernia with an uneventful inpatient recovery. In the literature, diaphragmatic liver herniation is a recognised complication secondary to trauma or congenital defects, however, to our knowledge, there are currently no cases described following pericardial windowing.
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Affiliation(s)
| | - Mark Kelly
- General Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Madeleine Garner
- General Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK
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Buoro S, Tombetti E, Ceriotti F, Simon C, Cugola D, Seghezzi M, Innocente F, Maestroni S, del Carmen Baigorria Vaca M, Moioli V, Previtali G, Manenti B, Adler Y, Imazio M, Brucato A. What is the normal composition of pericardial fluid? Heart 2020; 107:1584-1590. [DOI: 10.1136/heartjnl-2020-317966] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/04/2020] [Accepted: 10/07/2020] [Indexed: 12/21/2022] Open
Abstract
ObjectiveBiochemical and cytological pericardial fluid (PF) analysis is essentially based on the knowledge of pleural fluid composition. The aim of the present study is to identify reference intervals (RIs) for PF according to state-of-art methodological standards.MethodsWe prospectively collected and analysed the PF and venous blood of consecutive subjects undergoing elective open-heart surgery from July 2017 to October 2018. Exclusion criteria for study enrolment were evidence of pericardial diseases at preoperatory workup or at intraoperatory assessment, or any other condition that could affect PF analysis.ResultsThe final study sample included 120 patients (median age 69 years, 83 men, 69.1%). The main findings were (1) High levels of proteins, albumin and lactate dehydrogenase (LDH), but not of glucose and cholesterol (2) High cellularity, mainly represented by mesothelial cells. RIs for pericardial biochemistry were: protein content 1.7–4.6 g/dL PF/serum protein ratio 0.29–0.83, albumin 1.19–3.06 g/dL, pericardium-to-serum albumin gradient 0.18–2.37 g/dL, LDH 141–2613 U/L, PF/serum LDH ratio 0.40–2.99, glucose 80–134 mg/dL, total cholesterol 12–69 mg/dL, PF/serum cholesterol ratio 0.07–0.51. RIs for pericardial cells by optic microscopy were: 278–5608 × 106 nucleated cells/L, 40–3790 × 106 mesothelial cells/L, 35–2210 × 106 leucocytes/L, 19–1634 × 106 lymphocytes/L.ConclusionsPF is rich in nucleated cells, protein, albumin, LDH, at levels consistent with inflammatory exudates in other biological fluids. Physicians should stop to interpret PF as exudate or transudate according to tools not validated for this setting.
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Characteristic molecular signature of pericardial effusion identifies malignant cancer in pericardial disorder patients. Mol Cell Toxicol 2020. [DOI: 10.1007/s13273-020-00076-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lazaros G, Antonopoulos AS, Lazarou E, Vlachopoulos C, Foukarakis E, Androulakis A, Manginas A, Theodoros K, Karavidas A, Tousoulis D. Long-Term Outcome of Pericardial Drainage in Cases of Chronic, Large, Hemodynamically Insignificant, C-Reactive Protein Negative, Idiopathic Pericardial Effusions. Am J Cardiol 2020; 126:89-93. [PMID: 32345471 DOI: 10.1016/j.amjcard.2020.03.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 12/30/2022]
Abstract
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.
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Affiliation(s)
- George Lazaros
- 1(st) Cardiology Clinic, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece.
| | - Alexios S Antonopoulos
- 1(st) Cardiology Clinic, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece
| | - Emilia Lazarou
- 1(st) Cardiology Clinic, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece
| | - Charalambos Vlachopoulos
- 1(st) Cardiology Clinic, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece
| | - Emmanuel Foukarakis
- Department of Cardiology, Venizeleion General Hospital, Heraklion, Crete, Greece
| | | | | | - Kalos Theodoros
- 1(st) Cardiology Clinic, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece
| | - Apostolos Karavidas
- 1(st) Cardiology Clinic, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece
| | - Dimitris Tousoulis
- 1(st) Cardiology Clinic, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece
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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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Villanueva DLE, Regalado JJ, Uy-Agbayani C. A Rare Case of Pericardial Decompression Syndrome in a Filipino Female Patient With Suspected Malignant Pericardial Effusion. J Med Cases 2020; 11:86-89. [PMID: 34434371 PMCID: PMC8383577 DOI: 10.14740/jmc3446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/23/2020] [Indexed: 12/27/2022] Open
Abstract
Pericardial decompression syndrome (PDS) is a rare, under-reported and potentially fatal complication of pericardial drainage characterized by paradoxical hemodynamic deterioration. The onset ranges from immediate to as long as 48 h post drainage. We present a case of a 51-year-old woman admitted due to progressive dyspnea. She was hemodynamically stable but with signs of cardiac tamponade. On two-dimensional echocardiography (2D-echo) there was a massive pericardial effusion in tamponade physiology. Immediate surgical drainage was done but intra-operatively there was depressed cardiac contractility necessitating inotropic support. Post-operative 2D-echo showed right ventricular (RV) and left ventricular (LV) systolic dysfunction. She was admitted in the intensive care unit (ICU) for 72 h. Repeat 2D-echo showed marked improvement in RV and LV systolic function. She was then discharged improved on the fifth hospital day. The pathophysiology of PDS is still not very clear. The simplest mechanism is that sudden removal of compressing pericardial fluid causes increased venous return with expansion of the RV at the expense of the LV leading to acute heart failure. There are no published studies to propose preventive measures and treatment remains supportive. There has been only one published case reported here in our country. We report this case of a patient who successfully recovered from PDS.
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Affiliation(s)
- Danielle Louis E Villanueva
- Division of Cardiovascular Medicine, University of the Philippines, Philippine General Hospital, Manila 1000, Philippines
| | - Joseph Justin Regalado
- Division of Cardiovascular Medicine, University of the Philippines, Philippine General Hospital, Manila 1000, Philippines
| | - Celia Uy-Agbayani
- Division of Cardiovascular Medicine, University of the Philippines, Philippine General Hospital, Manila 1000, Philippines
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Chiabrando JG, Bonaventura A, Vecchié A, Wohlford GF, Mauro AG, Jordan JH, Grizzard JD, Montecucco F, Berrocal DH, Brucato A, Imazio M, Abbate A. Management of Acute and Recurrent Pericarditis. J Am Coll Cardiol 2020; 75:76-92. [DOI: 10.1016/j.jacc.2019.11.021] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022]
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[Management of pericarditis and pericardial effusion, constrictive and effusive-constrictive pericarditis]. Herz 2019; 43:663-678. [PMID: 30315402 DOI: 10.1007/s00059-018-4744-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This CME review takes stock of the progress in the etiology, pathophysiology, diagnostics and treatment of pericarditis and pericardial effusion brought about by the publication of the 2nd European Society of Cardiology (ESC) guidelines on the management of pericardial diseases in 2015. It also emphasizes special forms, which have received less attention in the past, such as therapy-refractory (incessant), effusive-constrictive and constrictive pericarditis and the treatment of acute and recurrent pericarditis with colchicine. After the diagnosis of pericarditis with or without effusion has been made, the first step is to clarify its etiology, which affects the clinical symptoms, course, treatment and the prognosis. In this aspect the requirements of the guidelines and the reality of an etiological classification of pericardial diseases diverge in many cases. The diagnosis of "idiopathic" acute or recurrent pericarditis is still much too often the result of insufficient efforts to find the cause. Too often only malignant and bacterial forms are excluded. If the etiology is known local intrapericardial treatment with the already inserted pigtail catheter from the diagnostic pericardial puncture can be carried out with few systemic side effects. The 2015 ESC guidelines recommend colchicine as first line treatment in all forms of pericarditis except for neoplastic pericardial effusion. It accelerates healing and reduces the frequency of recurrence of pericarditis but cannot eliminate recurrence completely. The best treatment and prevention of recurrence is the eradication of the underlying etiological cause.
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Buoro S, Seghezzi M, Baigorria Vaca MDC, Manenti B, Moioli V, Previtali G, Simon C, Cugola D, Brucato A, Ottomano C, Lippi G. Comparison between optical microscopy and automation for cytometric analysis of pericardial fluids in a cohort of adult subjects undergoing cardiac surgery. J Clin Pathol 2019; 72:493-500. [DOI: 10.1136/jclinpath-2019-205788] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/28/2019] [Accepted: 03/28/2019] [Indexed: 01/04/2023]
Abstract
AimsLimited information is available on number and type of cells present in the pericardial fluid (PF). Current evidence and has been garnered with inaccurate application of guidelines for analysis of body fluids. This study was aimed at investigating the performance of automate cytometric analysis of PF in adult subjects.MethodsSeventy-four consecutive PF samples were analysed with Sysmex XN with a module for body fluid analysis (XN-BF) and optical microscopy (OM). The study also encompassed the assessment of limit of blank, limit of detection and limit of quantitation (LoQ), imprecision, carryover and linearity of XN-BF module.ResultsXN-BF parameters were compared with OM for the following cell classes: total cells (TC), leucocytes (white blood cell [WBC]), polymorphonuclear (PMN) and mononuclear (MN) cells. The relative bias were −4.5%, 71.2%, 108.2% and −47.7%, respectively. Passing and Bablok regression yielded slope comprised between 0.06 for MN and 5.8 for PMN, and intercept between 0.7 for PMN and 220.3 for MN. LoQ was comprised between 3.8×106 and 6.0×106 cells/L for WBC and PMN. Linearity was acceptable and carryover negligible.ConclusionsPF has a specific cellular composition. Overall, automated cell counting can only be suggested for total number of cells, whereas OM seems still the most reliable option for cell differentiation.
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Di Liso E, Menichetti A, Dieci MV, Ghiotto C, Banzato A, Bianchi A, Pintacuda G, Padovan M, Nappo F, Cumerlato E, Miglietta F, Mioranza E, Zago G, Corti L, Guarneri V, Conte P. Neoplastic Pericardial Effusion: A Monocentric Retrospective Study. J Palliat Med 2019; 22:691-695. [PMID: 30888908 DOI: 10.1089/jpm.2018.0491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Neoplastic pericardial effusion (NPE) is a life-threatening condition that can worsen clinical outcome in cancer patients. The optimal management of NPE has yet to be defined because randomized studies are lacking. Objective: We report a retrospective monoinstitutional experience describing characteristics, management and prognostic factors in NPE patients. Design: We reviewed clinical, pathological, and echocardiographic features, therapeutic strategies, and outcome in NPE patients referred to our institute from August 2011 to December 2017. Measurements: Twenty-nine patients with NPE from solid tumors have been identified: 21 lung, 5 breast, and 3 other cancer patients. Results: Median age was 62 years. Most of the patients had Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥2 (69%) and a symptomatic NPE (69%). In 52% of patients NPE was detected at first diagnosis of metastatic disease, and in 20% of patients pericardium was the only site of metastases. Most of the patients (62%) received systemic therapy, 28% received combined locoregional and systemic therapy, and 10% received locoregional therapy alone. Median overall survival (OS) from NPE diagnosis was 3.9 months. Patients with PS ≥2 had worse OS than patients with better PS <2 (hazard ratio [HR] 3.56, IC 95% 1.19-10.65, p 0.02). Older age, extrapericardial disease, and NPE at progression showed a trend of association with worse OS. Patients treated with locoregional therapy alone showed the shortest median OS (p 0.05). Conclusions: NPE is related to dismal prognosis. Poor PS significantly worsens survival and influences therapeutic approaches. Randomized studies are required to investigate prognostic factors and appropriate clinical management for patients with NPE.
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Affiliation(s)
- Elisabetta Di Liso
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Alice Menichetti
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Maria Vittoria Dieci
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy.,2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Cristina Ghiotto
- 2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Alberto Banzato
- 3 Cardiology Unit, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | | | | | - Marta Padovan
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Floriana Nappo
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Enrico Cumerlato
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Federica Miglietta
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Eleonora Mioranza
- 2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Giulia Zago
- 2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Luigi Corti
- 5 Radiotherapy Unit, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Valentina Guarneri
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy.,2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Pierfranco Conte
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy.,2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
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De Filippo O, Gatti P, Rettegno S, Iannaccone M, D’Ascenzo F, Lazaros G, Brucato A, Tousoulis D, Adler Y, Imazio M. Is pericardial effusion a negative prognostic marker? Meta-analysis of outcomes of pericardial effusion. J Cardiovasc Med (Hagerstown) 2019; 20:39-45. [DOI: 10.2459/jcm.0000000000000720] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Jaing TH, Chen SH, Wen YC, Chang TY, Tsai DY, Chung HT, Tsay PK. Factors Affecting Survival in Children With Pericardial Effusion After Hematopoietic Stem Cell Transplantation. Cell Transplant 2018; 26:1792-1797. [PMID: 29338379 PMCID: PMC5784522 DOI: 10.1177/0963689717727285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The objective of this study was to determine the incidence, risk factors, outcome, and clinical significance of pericardial effusion (PE). We retrospectively analyzed outcomes of 272 pediatric patients undergoing their first hematopoietic stem cell transplantation (HSCT) from 1998 to 2016. In total, 15% (3/20) and 5.9% (15/252) of autologous and allogeneic HSCT recipients, respectively, were identified with PE. However, there was no statistically significant difference in the incidence of PE between the 2 groups. The mean age at transplantation was 11.12 ± 5.41 y. Eighteen patients developed PE at 4.13 ± 4.44 mo after HSCT. PE was confirmed by echocardiogram in all patients. Three patients presented with severe PE with cardiac tamponade and required urgent pericardiocentesis. Overall survival (OS) rates for patients who developed PE were 83.3% and 38.9% at 100 d and 3 y, respectively, after HSCT. Death was not directly attributable to PE in patients who died in the first year after HSCT. Multivariable analysis identified the following variables to be associated with OS: PE (relative risk[RR]: 3.70; 95% confidence interval [95% CI]: 1.89-7.23; P < 0.001), active disease at HSCT (RR: 1.59; 95% CI: 1.02-2.49; P < 0.001), and thalassemia (RR: 0.62; 95% CI: 0.45-0.84; P < 0.001). PE is, thus, a debilitating and significant complication of pediatric HSCT. Therefore, prospective studies are required for better determination of the etiology and optimal method of PE treatment after HSCT.
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Affiliation(s)
- Tang-Her Jaing
- 1 Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Linkou, Taoyuan
| | - Shih-Hsiang Chen
- 1 Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Linkou, Taoyuan
| | - Yu-Chuan Wen
- 2 Department of Nursing, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan
| | - Tsung-Yen Chang
- 1 Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Linkou, Taoyuan
| | - Dai-Yun Tsai
- 2 Department of Nursing, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan
| | - Hung-Tao Chung
- 3 Division of Cardiology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Linkou, Taoyuan
| | - Pei-Kwei Tsay
- 4 Department of Public Health and Center of Biostatistics, College of Medicine, Chang Gung University, Linkou, Taoyuan, Taiwan
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Harmon TS, Wynn G, Meyer TE, Siragusa D, Matteo J. Complicated Complication: How Interventional Radiologists Should Manage Acute Iatrogenic Cardiac Tamponade. Cureus 2018; 10:e3708. [PMID: 30788197 PMCID: PMC6372255 DOI: 10.7759/cureus.3708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Computed tomography guided biopsies are common interventional procedures that are necessary for confirmation of imaging findings. Additionally, percutaneous biopsies are necessary for the elucidation of a patient’s clinical findings with disease pathology. Though interventionists perform these procedures regularly without consequence, various complications may arise depending on the tissues biopsied. Examples of such complications may include hemorrhage, hematoma formation, or perforation of surrounding vessels. In the case of mediastinal biopsies, less common but higher-risk complications may include pneumothorax, perforation of arterial vessels, and damage to the cardiac tissues resulting in decompensation. Interventionists should understand the risks of performing these procedures and should be prepared to intervene if life-threatening complications arise. As interventional cardiologists are often prepared to manage decompensating cardiac complications, interventional radiologists must likewise anticipate the same to occur when conducting procedures that may affect cardiac tissues. The following case demonstrates a technique for correcting a complicated complication arising from a mediastinal biopsy, which resulted in a pericardial effusion and patient decompensation.
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Affiliation(s)
- Taylor S Harmon
- Radiology, University of Texas Medical Branch, Galveston, USA
| | - Gregory Wynn
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Travis E Meyer
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Daniel Siragusa
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Jerry Matteo
- Radiology, University of Florida College of Medicine, Jacksonville, USA
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Imazio M, Lazaros G, Valenti A, De Carlini CC, Maggiolini S, Pivetta E, Giustetto C, Tousoulis D, Adler Y, Rinaldi M, Brucato A. Outcomes of idiopathic chronic large pericardial effusion. Heart 2018; 105:477-481. [DOI: 10.1136/heartjnl-2018-313532] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/24/2018] [Accepted: 08/30/2018] [Indexed: 11/04/2022] Open
Abstract
ObjectiveAim of this paper is to evaluate the outcomes of ‘idiopathic’ chronic large pericardial effusions without initial evidence of pericarditis.MethodsAll consecutive cases of idiopathic chronic large pericardial effusions evaluated from 2000 to 2015 in three Italian tertiary referral centres for pericardial diseases were enrolled in a prospective cohort study. The term ‘idiopathic’ was applied to cases that performed a complete diagnostic evaluation to exclude a specific aetiology. A clinical and echocardiographic follow-up was performed every 3–6 months.Results100 patients were included (mean age 61.3±14.6 years, 54 females, 44 patients were asymptomatic according to clinical evaluation) with a mean follow-up of 50 months. The baseline median size of the effusion (evaluated as the largest end-diastolic echo-free space) was 25 mm (IQR 8) and decreased to a mean value of 7 mm (IQR 19; p<0.0001) with complete regression in 39 patients at the end of follow-up. There were no new aetiological diagnoses. Adverse events were respectively: cardiac tamponade in 8 patients (8.0%), pericardiocentesis in 30 patients (30.0%), pericardial window in 12 cases (12.0%) and pericardiectomy in 3 patients (3.0%). Recurrence-free survival and complications-free survival was better in patients treated without interventions (log rank p=0.0038).ConclusionsThe evolution of ‘idiopathic’ chronic large pericardial effusions is usually benign with reduction of the size of the effusion in the majority of cases, and regression in about 40% of cases. The risk of cardiac tamponade is 2.2%/year and recurrence/complications survival was better in patients treated conservatively without interventions.
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Darocha S, Wilk M, Walaszkowska-Czyż A, Kępski J, Mańczak R, Kurzyna M, Torbicki A, Szmit S. Determinants of Survival After Emergency Intrapericardial Cisplatin Treatment in Cancer Patients with Recurrent Hemodynamic Instability After Pericardiocentesis. ACTA ACUST UNITED AC 2018; 32:373-379. [PMID: 29475923 DOI: 10.21873/invivo.11248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 12/17/2017] [Accepted: 12/21/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pericardial effusion is associated with high mortality in oncology. The etiology of infectious pericarditis and iatrogenic effects of previous radio-/chemotherapy may be always suspected, especially when a subsequent episode is observed. PATIENTS AND METHODS The study included 17 hemodynamically-unstable patients with cancer due to recurrent pericardial bloody effusion after previous pericardiocentesis and analyzed survival determinants after intrapericardial chemotherapy with cisplatin. RESULTS The mortality rate was not significantly associated with the level of N-terminal pro-B type natriuretic peptide, low hemoglobin (<12 g/dl), elevated white blood cell account (>104/μl), large volume (>1500 ml) and long duration (>8 days) of pericardial drainage, cardiac arrhythmias, positive culture test results nor fever occurring during cisplatin administration. Subsequent systemic anticancer therapy was the strongest factor determining a longer survival (hazard ratio(HR)=0.31, 95% confidence interval(CI)=0.11-0.9; p=0.03). CONCLUSION Efficacy of rescue intrapericardial chemotherapy with cisplatin is independent of parameters of hemodynamic instability and levels of inflammatory markers in recurrent pericardial effusion.
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Affiliation(s)
- Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Michał Wilk
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland.,Department of Clinical Oncology, European Health Centre, Otwock, Poland
| | | | - Jarosław Kępski
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Rafał Mańczak
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Sebastian Szmit
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
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Volk L, Ikegami H, Lee LY, Lemaire A. Pericardial windows have limited diagnostic success. J Cardiothorac Surg 2018; 13:87. [PMID: 30021617 PMCID: PMC6052520 DOI: 10.1186/s13019-018-0774-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 07/10/2018] [Indexed: 12/31/2022] Open
Abstract
Background Pericardial effusion (PE) is a common finding in patients who have chronic cardiac failure, who had undergone cardiac surgery, or who have certain other benign and malignant diseases. Pericardial drainage procedures are often requested for both diagnostic and therapeutic purposes. The perceived benefit is that it allows for diagnosis of malignancy or infection for patients with PEs of unclear etiology. The purpose of the study is to determine the diagnostic yield of surgical drainage procedures. Methods We conducted a retrospective chart review of patients who underwent surgical drainage procedures of PEs from July 1st, 2011 to January 1st, 2017 at a single institution. The variables included data on preoperative, intraoperative, and postoperative findings; morbidity; and survival. Results A total of 145 patients with an average age of 61 ± 5 and primarily men (53%) were evaluated. All of the surgical drainage procedures were performed through the sub-xiphoid approach. Twenty-five of the 145 patients (17.2%) had diagnostic findings in either the pericardial tissue or fluid. The cytology alone was diagnostic in 4.8% (N = 7) of patients with mixed findings including adenocarcinoma of the lung and breast. The pathology was diagnostic for cancer in 1.4% (N = 2) of patients with Melanoma and Lung cancer identified. The cytology and pathology were concordant in 4.0% (N = 6) identifying cancers that included mesothelioma and adenocarcinoma. Infection was identified in the pericardial fluid in 6.9% (N = 10) of the patients. Conclusion Surgical pericardial drainage procedures allow for removal of PE that may lead to tamponade physiology and potential mortality. Although there is therapeutic benefit from these procedures there is only a small diagnostic benefit.
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Affiliation(s)
- Lindsay Volk
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08903, USA
| | - Hirohisa Ikegami
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08903, USA
| | - Leonard Y Lee
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08903, USA
| | - Anthony Lemaire
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08903, USA.
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Trout GO, Hoz RDL, Alfaro LM, Córdoba AP, Consuegra GA. Manejo de derrame pericárdico: revisión sistemática de la literatura. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2017.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Paiardi S, Pellegrino M, Cannata F, Bocciolone M, Voza A. Transitory effusive-constrictive pericarditis. Am J Emerg Med 2017; 36:524.e1-524.e6. [PMID: 29169889 DOI: 10.1016/j.ajem.2017.11.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 10/19/2017] [Accepted: 11/17/2017] [Indexed: 12/28/2022] Open
Abstract
Pericardial effusion of various sizes is a quite common clinical finding, while its progression to effusive-constrictive pericarditis occurs in about 1.4-14% of cases. Although available evidence on prevalence and prognosis of this rare pericardial syndrome is poor, apparently a considerable proportion of patients conservatively managed has a spontaneous resolution after several weeks. A 61-year-old female presented to our emergency department reporting fatigue, effort dyspnea and abdominal swelling. The echocardiography showed large pericardial effusion with initial hemodynamic impact, so she underwent a pericardiocentesis with drainage of 800-850cm3 of exudative fluid, on which diagnostic investigations were undertaken: possible viral and bacterial infections, medical conditions, iatrogenic causes, neoplastic and connective tissue diseases were all excluded. Despite empirical therapy with NSAIDs and colchicine, after about one week she had a recurrence of pericardial effusion and progressive development of constriction. Echocardiography performed after a few weeks of anti-inflammatory therapy showed resolution of constriction and PE, with clinical improvement. If progression of pericardial syndromes to a constrictive form is rarely described in literature, cases of transitory effusive-constrictive phase are even more uncommon, mainly reported during the evolution of pericardial effusion. According to the available data, risk of progression to a constrictive form is very low in case of idiopathic pericardial effusion. We report a case of large idiopathic subacute pericardial effusion, treated with pericardiocentesis and then evolved into an effusive-constrictive pericarditis. A prolonged anti-inflammatory treatment leads to complete resolution of pericardial syndrome without necessity of pericardiectomy.
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Affiliation(s)
- Silvia Paiardi
- Emergency Department, Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy.
| | - Marta Pellegrino
- Cardiovascular Department, Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy.
| | - Francesco Cannata
- Cardiovascular Department, Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy.
| | - Monica Bocciolone
- Cardiovascular Department, Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy.
| | - Antonio Voza
- Emergency Department, Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy.
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Wiyeh AB, Ochodo EA, Wiysonge CS, Kakia A, Awotedu AA, Ristic A, Mayosi BM. A systematic review of the efficacy and safety of intrapericardial fibrinolysis in patients with pericardial effusion. Int J Cardiol 2017; 250:223-228. [PMID: 29107356 DOI: 10.1016/j.ijcard.2017.10.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 10/13/2017] [Indexed: 11/30/2022]
Abstract
Pericardial effusion is the abnormal accumulation of fluid in the pericardial space. The complications of pericardial effusion can either be acute (e.g., cardiac tamponade) or chronic (e.g., constrictive pericarditis). We have conducted a systematic review of the scientific literature to evaluate the efficacy and safety of intrapericardial fibrinolysis in preventing complications of pericardial effusion. We searched for both published and unpublished studies. 29 studies, with a total of 109 patients were included in this review; 17 case reports, 11 case series, and one randomised controlled trial (RCT). All included studies had a high risk of bias. The most common causes of pericardial effusion were Staphylococcus aureus (12 studies with 23 cases) and Mycobacterium tuberculosis (2 studies with 19 cases). The most common fibrinolytic agents used were streptokinase (15 studies) and urokinase (5 studies). Intrapericardial fibrinolysis prevented complications in 94 (86.2%) patients. Non-fatal procedure-related complications were reported 21 (19.2%) patients. No patient died following intrapericardial fibrinolysis. There is very low certainty of the efficiency and safety of intrapericardial fibrinolysis in preventing the complications of pericardial effusion. High quality RCTs are required to address this question.
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Affiliation(s)
- Alison B Wiyeh
- Centre for Evidence-based Health Care, Department of Global Health, Stellenbosch University, Cape Town, South Africa; Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
| | - Eleanor A Ochodo
- Centre for Evidence-based Health Care, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
| | - Aloysious Kakia
- Department of Family Medicine and Rural Health, Walter Sisulu University, Mthatha, South Africa
| | - Abolade A Awotedu
- Department of Medicine, Nelson Mandela Academic Hospital and Walter Sisulu University, Mthatha, South Africa
| | - Arsen Ristic
- Department of Cardiology, Clinical Centre of Serbia and Belgrade University School of Medicine, Belgrade, Serbia.
| | - Bongani M Mayosi
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
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Kato R, Hayashi H, Chiba Y, Tanaka K, Takeda M, Nakagawa K. Prognostic Impact of Minimal Pericardial Effusion in Patients With Advanced Non-small-cell Lung Cancer. Clin Lung Cancer 2017; 18:e449-e455. [PMID: 28576595 DOI: 10.1016/j.cllc.2017.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/26/2017] [Accepted: 05/02/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Minimal (< 10 mm in thickness) pericardial effusion (PCE) can be incidentally detected by computed tomography at the time of diagnosis in patients with lung cancer. Although malignant PCE is known to be associated with poor prognosis, the impact of minimal PCE on outcome has remained unclear. We therefore examined the prognostic relevance of minimal PCE in patients with advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS We retrospectively analyzed consecutive patients diagnosed with stage IV NSCLC at Kindai University Hospital between April 2009 and March 2015. The patients were classified into 3 groups on the basis of the presence and thickness of PCE: no PCE, minimal (< 10 mm) PCE, and malignant (≥ 10 mm) PCE. The relation between overall survival and PCE status was examined with a Cox proportional hazards model. RESULTS The total of 428 enrolled patients included 327 (76.4%) in the no PCE group, 61 (14.3%) in the minimal PCE group, and 40 (9.3%) in the malignant PCE group. Median overall survival was 15.0, 10.1, and 7.6 months in the no PCE, minimal PCE, and malignant PCE groups, respectively, with the survival of patients with minimal PCE thus being intermediate between that of the other 2 groups (P = .003). Multivariable analysis revealed that minimal PCE was independently associated with reduced survival (hazard ratio, 1.46; 95% confidence interval, 1.07-1.96; P = .019). CONCLUSIONS The presence of minimal PCE was an independent prognostic factor for reduced survival in patients with advanced NSCLC.
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Affiliation(s)
- Ryoji Kato
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hidetoshi Hayashi
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka, Japan.
| | - Yasutaka Chiba
- Clinical Research Center, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kaoru Tanaka
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masayuki Takeda
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kazuhiko Nakagawa
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka, Japan
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Imazio M, Gaido L, Battaglia A, Gaita F. Contemporary management of pericardial effusion: practical aspects for clinical practice. Postgrad Med 2017; 129:178-186. [PMID: 28135875 DOI: 10.1080/00325481.2017.1285676] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A pericardial effusion (PE) is a relatively common finding in clinical practice. It may be either isolated or associated with pericarditis with or without an underlying disease. The aetiology is varied and may be either infectious (especially tuberculosis as the most common cause in developing countries) or non-infectious (cancer, systemic inflammatory diseases). The management is essentially guided by the hemodynamic effect (presence or absence of cardiac tamponade), the presence of concomitant pericarditis or underlying disease, and its size and duration. The present paper reviews the current knowledge on the aetiology, classification, diagnosis, management, therapy, and prognosis of PE in clinical practice.
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Affiliation(s)
- Massimo Imazio
- a Department of Medical Sciences , University Cardiology, AOU Città della Salute e della Scienza di Torino, and University of Torino , Torino , Italy
| | - Luca Gaido
- a Department of Medical Sciences , University Cardiology, AOU Città della Salute e della Scienza di Torino, and University of Torino , Torino , Italy
| | - Alberto Battaglia
- a Department of Medical Sciences , University Cardiology, AOU Città della Salute e della Scienza di Torino, and University of Torino , Torino , Italy
| | - Fiorenzo Gaita
- a Department of Medical Sciences , University Cardiology, AOU Città della Salute e della Scienza di Torino, and University of Torino , Torino , Italy
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He B, Yang Z, Zhao P, Li YJ, Wang JG. Cytopathologic analysis of pericardial effusions in 116 cases: Implications for poor prognosis in lung cancer patients with positive interpretations. Diagn Cytopathol 2017; 45:287-293. [PMID: 28139896 DOI: 10.1002/dc.23671] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 12/09/2016] [Accepted: 01/12/2017] [Indexed: 01/23/2023]
Affiliation(s)
- Bing He
- Department of Pathology; School of Basic Medicine, Qingdao University; Qingdao 266071 China
- Department of Pathology; The Affiliated Hospital of Qingdao University; Qingdao 266003 China
| | - Zhen Yang
- Department of Pathology; The Affiliated Hospital of Qingdao University; Qingdao 266003 China
| | - Peng Zhao
- Department of Pathology; The Affiliated Hospital of Qingdao University; Qingdao 266003 China
| | - Yu-Jun Li
- Department of Pathology; The Affiliated Hospital of Qingdao University; Qingdao 266003 China
| | - Ji-Gang Wang
- Department of Pathology; The Affiliated Hospital of Qingdao University; Qingdao 266003 China
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Imazio M, Pedrotti P, Quattrocchi G, Roghi A, Badano L, Faletti R, Bogaert J, Gaita F. Multimodality imaging of pericardial diseases. J Cardiovasc Med (Hagerstown) 2016; 17:774-82. [DOI: 10.2459/jcm.0000000000000427] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Eleven years after the publication of the first guidelines worldwide on pericardial diseases by the European Society of Cardiology (ESC), the international expert group of the ESC has updated the original document of 28 pages with 275 references. The final version of the new guidelines is more voluminous with 44 pages of recommendations but only 233 references. A continuing medical education (CME) certified update of the 2004 guidelines was published in the journal Herz volume 7/2014. In comparison to 2004 the 2015 guidelines have remained virtually unchanged in the sections detailing diagnostics, differential diagnosis, pathology and pathophysiology. Substantial progress has been made in magnetic resonance imaging (MRI) of pericarditis and epicarditis and in the practically universal recommendation of colchicine for all forms of pericarditis and pericardial effusion, whether acute, chronic or recurrent. This can truly be called progress; however, little has changed since 2004 even in tertiary referral centers or universities with respect to the etiological classification of acute or recurrent forms of pericarditis or pericardial effusion. By classifying pericardial syndromes much too often as idiopathic when a malignant or bacterial cause has been excluded, the underlying cause is often overlooked. Standstill in diagnosis is in the end regress because we too often lag behind our actual diagnostic and interventional possibilities.
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Imazio M, Brucato A, Badano L, Charron P, Adler Y. Whatʼs new in 2015 ESC guidelines on pericardial diseases? J Cardiovasc Med (Hagerstown) 2016; 17:315-22. [DOI: 10.2459/jcm.0000000000000358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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