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

  • E. KızıltunçEmail author
  • S. Ünlü
  • İ. E. Yakıcı
  • H. Kundi
  • A. Korkmaz
  • M. Çetin
  • E. Örnek
Original articles
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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.

Keywords

Pericardial effusion Pericardial tamponade Prognosis Pericardiocentesis Etiology 

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

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.

Schlüsselwörter

Perikarderguss Perikardtamponade Prognose Perikardpunktion Ätiologie 

Notes

Compliance with ethical guidelines

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.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • E. Kızıltunç
    • 1
    Email author
  • S. Ünlü
    • 2
  • İ. E. Yakıcı
    • 1
  • H. Kundi
    • 1
    • 3
  • A. Korkmaz
    • 1
  • M. Çetin
    • 1
  • E. Örnek
    • 1
  1. 1.Cardiology DepartmentNumune Education and Research HospitalAnkaraTurkey
  2. 2.Cardiology DepartmentAtatürk Chest Diseases and Chest Surgery Education and Research HospitalAnkaraTurkey
  3. 3.Cardiology DepartmentBeth Israel Deaconess Medical CenterBostonUSA

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