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Epicardial halo phenomenon: a guide for pericardiocentesis?

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Abstract

The epicardial halo delineates the heart shadow in fluoroscopy. To establish whether the sign is applicable to pericardiocentesis guidance, three investigators evaluated its intensity as absent = grade 0, indistinct = 0.5, clear = 1, intensive = 2 in posterior–anterior (PA) and lateral fluoroscopies recorded before pericardiocentesis or cardiac catheterization (Philips Integris-II BH3000). Three populations were studied: (a) 32 patients with pericardial effusion (PE group), 53.1 % males, aged 53.9 ± 13.9 years; (b) 14 patients with perimyocarditis (PM group), 64.3 % males, aged 51.6 ± 14.4 years; and (c) 46 coronary patients (CAD group), no PE, 95.6 % males, aged 67.3 ± 11.8 years. The intensity of the halo phenomenon was highest in patients with PE, lowest in patients with CAD, and intermediate in patients with PM (median sum of grades in PA/lateral view: 4/5 vs. 2/2.5 vs. 3/3, respectively) (p < 0.01). The halo phenomenon correlated well with HR and echocardiographic PE size in both angiographic views. The correlation with body mass index (BMI) and age was significant only in the lateral view and with PE volume only in the PA view. The sensitivity of the halo sign for PE was 84.1 % in PA and 92.0 % in lateral views. In 10/32 PE patients, the evaluation of the sign was repeated after PE drainage, revealing lower grades both in PA and in lateral views (p < 0.01). In conclusion, the epicardial halo sign is highly sensitive for the detection of a PE; it correlates well in at least one angiographic projection with the PE volume, HR, age, BMI, and the PE size in echocardiography and could be therefore applied as a safety guide for pericardiocentesis.

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Abbreviations

BMI:

Body mass index

HR:

Heart rate

PA:

Posterior–anterior

PE:

Pericardial effusion

PEDMIN:

Minimal diastolic size of PE in echocardiography

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Acknowledgments

The authors greatly appreciate the research fellowship grant from the European Society of Cardiology, the Twin Centers Grant from the World Heart Federation and Cardiac Promotion Society, Marburg for Dr. A.D. Ristić, and the grant of the Verein zur Förderung der Kardiologie Marburg for the entire project.

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The authors have no conflicts of interest or financial ties to disclose.

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Correspondence to Arsen D. Ristić.

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Ristić, A.D., Wagner, HJ., Maksimović, R. et al. Epicardial halo phenomenon: a guide for pericardiocentesis?. Heart Fail Rev 18, 307–316 (2013). https://doi.org/10.1007/s10741-012-9326-y

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  • DOI: https://doi.org/10.1007/s10741-012-9326-y

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