Skip to main content

Advertisement

SpringerLink
Log in

Clinical characteristics and prognosis of cardiac tamponade patients: 5‑year experience at a tertiary center

Klinische Merkmale und Prognose bei Patienten mit Herztamponade: 5 Jahre Erfahrung in einem Tertiärzentrum

  • Original articles
  • Published:
Herz Aims and scope Submit manuscript

Abstract

Background

Cardiac tamponade (CT) is characterized by compression of the cardiac chambers due to pericardial fluid accumulation. The etiology and prognosis may vary in different regions, and thus patient series from various regions can be useful for exploring the etiological and prognostic disparities. The aim of this study was to determine the clinical characteristics of patients with imminent CT, to evaluate the diagnostic performance of biochemical, microbiologic, and pathologic laboratory analysis, and to ascertain the prognosis of CT patients.

Methods

We enrolled all patients with imminent CT who underwent percutaneous pericardiocentesis between July 2012 and December 2017 in this retrospective study. The patients were classified into three etiology groups: (a) malignancy (MRCT); (b) iatrogenic/mechanical complication of myocardial infarction (IMCT); and (c) other causes (OCT). Clinical information, laboratory findings, and survival data were recorded.

Results

In total, 186 pericardiocentesis procedures were performed on 153 consecutive patients with CT. The median follow-up was 137 days (range: 1–1937). The MRCT group had the highest mortality rate (79%) in 12 months, while the OCT group had the lowest rate (27%). We determined that increased age, higher serum urea levels, and malignancy-related CT were independent predictors of mortality. The mortality rates of the MRCT and IMCT groups were similar, with both of them being significantly higher than the rate of the OCT group. In all, 15 patients were diagnosed with a new malignancy via pericardial fluid cytology.

Conclusion

Patients in the MRCT and IMCT groups had a poor prognosis. The presence of malignancy was found to be the most powerful predictor of mortality in CT patients.

Zusammenfassung

Hintergrund

Bei einer Herztamponade kommt es zur Kompression der Herzkammern aufgrund perikardialer Flüssigkeitsansammlung. Ätiologie und Prognose sind möglicherweise in verschiedenen Regionen unterschiedlich, daher können Fallserien aus verschiedenen Regionen für die Untersuchung ätiologischer und prognostischer Ungleichheiten nützlich sein. Ziel der vorliegenden Studie war es, die klinischen Merkmale von Patienten mit drohender Herztamponade zu identifizieren, die diagnostische Aussagekraft biochemischer, mikrobiologischer und pathologischer Laboruntersuchungen zu bestimmen und die Prognose solcher Patienten zu ermitteln.

Methoden

In diese retrospektive Studie wurden sämtliche Patienten mit drohender Herztamponade einbezogen, bei denen zwischen Juli 2012 und Dezember 2017 eine perkutane Perikardpunktion erfolgte. Dabei wurden die Patienten in 3 ätiologische Gruppen eingeteilt: (a) Malignom (MRCT); (b) iatrogene/mechanische Komplikation eines Myokardinfarkts (IMCT); (c) sonstige Ursachen (OCT). Klinische Daten, Laborergebnisse und Daten zum Überleben wurden dokumentiert.

Ergebnisse

Es wurden 186 Perikardpunktionen bei 153 aufeinanderfolgenden Patienten durchgeführt. Im Mittel betrug die Follow-up-Dauer 137 Tage (1–1937). Bei der MRCT-Gruppe bestand die höchste Mortalitätsrate in 12 Monaten (79%), bei der OCT-Gruppe dagegen die niedrigste (27%). Höheres Alter, höhere Serumharnstoffwerte und eine malignombedingte Herztamponade erwiesen sich als unabhängige Prädiktoren der Mortalität. Die Mortalitätsraten in der MRCT- und der IMCT-Gruppe waren ähnlich, beide signifikant höher als in der OCT-Gruppe. Bei 15 Patienten wurde die Diagnose eines bisher unbekannten Malignoms durch die zytologische Untersuchung der Perikardflüssigkeit gestellt.

Schlussfolgerung

Für Patienten in der MRCT- und der IMCT-Gruppe war die Prognose ungünstig. Das Vorliegen eines Malignoms stellte sich als der stärkste Prädiktor der Mortalität bei Patienten mit Herztamponade heraus.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lewinter MM, Hopkins WE (2015) Pericardial diseases. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E (eds) Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 10th edn. Elsevier Saunders, Philadelphia, pp 1639–1657

    Google Scholar 

  2. Imazio M, Adler Y (2013) Management of pericardial effusion. Eur Heart J 34(16):1186–1197

    PubMed  Google Scholar 

  3. Gluer R, Murdoch D, Haqqani HM, Scalia GM, Walters DL (2015) Pericardiocentesis – how to do it. Heart Lung Circ 24(6):621–625

    PubMed  Google Scholar 

  4. Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr. (1972) Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 77(4):507–513

    CAS  PubMed  Google Scholar 

  5. O’gara PT, Kushner FG, Ascheim DD et al (2013) 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 61(4):e78–e140

    PubMed  Google Scholar 

  6. Abaci A, Unlu S, Alsancak Y, Kaya U, Sezenoz B (2013) Short and long term complications of device closure of atrial septal defect and patent foramen ovale: meta-analysis of 28,142 patients from 203 studies. Catheter Cardiovasc Interv 82(7):1123–1138

    PubMed  Google Scholar 

  7. Mahapatra S, Bybee KA, Bunch TJ et al (2005) Incidence and predictors of cardiac perforation after permanent pacemaker placement. Heart Rhythm 2(9):907–911

    PubMed  Google Scholar 

  8. Mujovic N, Marinkovic M, Markovic N et al (2016) Management and outcome of periprocedural cardiac perforation and tamponade with radiofrequency catheter ablation of cardiac arrhythmias: a single medium-volume center experience. Adv Ther 33(10):1782–1796

    PubMed  PubMed Central  Google Scholar 

  9. Stathopoulos I, Kossidas K, Panagopoulos G, Garratt K (2013) Cardiac tamponade complicating coronary perforation during angioplasty: short-term outcomes and long-term survival. J Invasive Cardiol 25(10):486–491

    PubMed  Google Scholar 

  10. Sagrista-Sauleda J, Merce AS, Soler-Soler J (2011) Diagnosis and management of pericardial effusion. World J Cardiol 3(5):135–143

    PubMed  PubMed Central  Google Scholar 

  11. Permanyer-Miralda G (2004) Acute pericardial disease: approach to the aetiologic diagnosis. Heart 90(3):252–254

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Wilkes JD, Fidias P, Vaickus L, Perez RP (1995) Malignancy-related pericardial effusion. 127 cases from the Roswell Park Cancer Institute. Cancer 76(8):1377–1387

    CAS  PubMed  Google Scholar 

  13. Gornik HL, Gerhard-Herman M, Beckman JA (2005) Abnormal cytology predicts poor prognosis in cancer patients with pericardial effusion. J Clin Oncol 23(22):5211–5216

    PubMed  Google Scholar 

  14. Takayama T, Okura Y, Okada Y et al (2015) Characteristics of neoplastic cardiac tamponade and prognosis after pericardiocentesis: a single-center study of 113 consecutive cancer patients. Int J Clin Oncol 20(5):872–877

    PubMed  Google Scholar 

  15. Apodaca-Cruz A, Villarreal-Garza C, Torres-Avila B et al (2010) Effectiveness and prognosis of initial pericardiocentesis in the primary management of malignant pericardial effusion. Interact Cardiovasc Thorac Surg 11(2):154–161

    PubMed  Google Scholar 

  16. He B, Yang Z, Zhao P, Li YJ, Wang JG (2017) Cytopathologic analysis of pericardial effusions in 116 cases: Implications for poor prognosis in lung cancer patients with positive interpretations. Diagn Cytopathol 45(4):287–293

    PubMed  Google Scholar 

  17. Strobbe A, Adriaenssens T, Bennett J et al (2017) Etiology and Long-Term Outcome of Patients Undergoing Pericardiocentesis. J Am Heart Assoc 6(12). https://doi.org/10.1161/jaha.117.007598

    Article  PubMed  PubMed Central  Google Scholar 

  18. Sagrista-Sauleda J, Merce J, Permanyer-Miralda G, Soler-Soler J (2000) Clinical clues to the causes of large pericardial effusions. Am J Med 109(2):95–101

    CAS  PubMed  Google Scholar 

  19. Kenney RT, Li JS, Clyde WA Jr. et al (1993) Mycoplasmal pericarditis: evidence of invasive disease. Clin Infect Dis 17(Suppl 1):S58–S62

    PubMed  Google Scholar 

  20. Ballal N, Vyas H, Novelli V (1991) Acute purulent pericarditis in Omani children. J Trop Pediatr 37(5):232–234

    Article  CAS  Google Scholar 

  21. Adler Y, Charron P, Imazio M et al (2015) 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 36(42):2921–2964

    Article  Google Scholar 

  22. Reuter H, Burgess LJ, Louw VJ, Doubell AF (2007) The management of tuberculous pericardial effusion: experience in 233 consecutive patients. Cardiovasc J S Afr 18(1):20–25

    CAS  PubMed  Google Scholar 

  23. Akyuz S, Zengin A, Arugaslan E et al (2015) Echo-guided pericardiocentesis in patients with clinically significant pericardial effusion. Outcomes over a 10-year period. Herz 40(Suppl 2):153–159

    PubMed  Google Scholar 

  24. Cho BC, Kang SM, Kim DH et al (2004) Clinical and echocardiographic characteristics of pericardial effusion in patients who underwent echocardiographically guided pericardiocentesis: Yonsei Cardiovascular Center experience, 1993–2003. Yonsei Med J 45(3):462–468

    PubMed  Google Scholar 

  25. Sagrista-Sauleda J, Angel J, Permanyer-Miralda G, Soler-Soler J (1999) Long-term follow-up of idiopathic chronic pericardial effusion. N Engl J Med 341(27):2054–2059

    CAS  PubMed  Google Scholar 

  26. Rigopoulos AG, Ali M, Sakellaropoulos S et al (2017) Diagnostic approaches for pericardial effusions: Beyond mere cytopathology. Herz. https://doi.org/10.1007/s00059-017-4661-3

    Article  PubMed  Google Scholar 

  27. Tsang TS, Enriquez-Sarano M, Freeman WK et al (2002) Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns, and outcomes spanning 21 years. Mayo Clin Proc 77(5):429–436

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiology Department, Numune Education and Research Hospital, 06100, Ankara, Turkey

    E. Kızıltunç MD, İ. E. Yakıcı MD, H. Kundi MD, A. Korkmaz MD, M. Çetin MD & E. Örnek MD

  2. Cardiology Department, Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey

    S. Ünlü MD

  3. Cardiology Department, Beth Israel Deaconess Medical Center, Boston, MA, USA

    H. Kundi MD

Authors
  1. E. Kızıltunç MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Ünlü MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. İ. E. Yakıcı MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Kundi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Korkmaz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Çetin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. E. Örnek MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. Kızıltunç MD.

Ethics declarations

Conflict of interest

E. Kızıltunç, S. Ünlü, İ. Emre Yakıcı, H. Kundi, A. Korkmaz, M. Çetin, and E. Örnek declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kızıltunç, E., Ünlü, S., Yakıcı, İ.E. et al. Clinical characteristics and prognosis of cardiac tamponade patients: 5‑year experience at a tertiary center. Herz 45, 676–683 (2020). https://doi.org/10.1007/s00059-018-4769-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00059-018-4769-0

Keywords

Schlüsselwörter

Search

Navigation