Pericardial Effusion and Cardiac Tamponade in the New Millennium
Purpose of Review
The purpose of this paper is to review current approaches to the diagnosis and treatment of pericardial effusions and cardiac tamponade.
Recent recommendations from the American Society of Echocardiography and the European Society of Cardiology have refined our approaches to the patient with pericardial effusion and cardiac tamponade, but significant knowledge gaps remain. New diagnostic and triage strategies have been proposed, and recent data have advanced our ability to assess the presence and size of a pericardial effusion, assess its hemodynamic impact, and establish its cause.
Despite these recent findings, there is a paucity of evidence-based data to guide the management of pericardial effusion and cardiac tamponade. While the first-line function of echocardiography in managing these disorders is unquestioned, there are increasing niche roles for multimodality imaging.
KeywordsPericardial effusion Cardiac tamponade Echocardiography Multimodality imaging
Compliance with Ethical Standards
Conflict of Interest
Brian D. Hoit declares that he has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of Particular Interest, Published Recently, Have Been Highlighted as: • Of importance, •• Of major Importance
- 1.• Adler Y, Charron P, Imazio M, Badano L, Baron-Esquivias G, Bogaert J, et al. 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. 2015;36:2921–64. An exhaustive, authoritative document offering guidelines and recommendations (most representing a consensus of experts and/or small studies, retrospective studies, and registries) for all manifestations of pericardial disease. CrossRefPubMedGoogle Scholar
- 8.• Ma W, Liu J, Chen S, Chen S, Zheng Y, Ye S, et al. Causes of moderate to large pericardial effusion requiring pericardiocentesis in 140 Han Chinese patients. Herz. 2012;37:183–7. A contemporary review of the clinical characteristics and etiologies of moderate to large pericardial effusions that required drainage. Malignancy, infection, and iatrogenic were the three leading causes. CrossRefPubMedGoogle Scholar
- 11.•• Meurin P, LeLay-Kubas S, Pierre B, Pereira H, Pavy B, Iliou MC, et al. Colchicine for post-operative pericardial effusion. J Am Coll Cardiol. 2015;66:1198–9. A letter which describes the preliminary results of the POPE-2 study. In patients with a moderate to large pericardial effusion persisting one week after cardiac surgery, colchicine had no significant effect on the size of the effusion. CrossRefPubMedGoogle Scholar
- 13.•• Klein AL, Abbara S, Agler DA, Appleton CP, Asher CR, Hoit B, et al. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr. 2013;26:965–1012. A detailed, well-illustrated expert consensus statement from the ASE offering recommendations for integrated multimodality imaging in all manifestations of pericardial disease. CrossRefPubMedGoogle Scholar
- 18.Cogswell TL, Bernath GA, Raff H, Hoffmann RG, Klopfenstein HS. Total peripheral resistance during cardiac tamponade: adrenergic and angiotensin roles. Am J Phys. 1986;251:R916–22.Google Scholar
- 21.• Ristic AD, Imazio M, Adler Y, Anastasakis A, Badano LP, Brucato A, et al. Triage strategy for urgent management of cardiac tamponade: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2014;35:2279–84. A proposal for a step-wise scoring system based on the etiology, clinical presentation and imaging of pericardial effusions that identifies high risk patients requiring urgent pericardiocentesis and those patients that should be transferred to hospitals specializing in pericardial disease. CrossRefPubMedGoogle Scholar
- 26.Merce J, Sagrista-Sauleda J, Permanyer-Miralda G, Evangelista A, Soler-Soler J. Correlation between clinical and Doppler echocardiographic findings in patients with moderate and large pericardial effusion: implications for the diagnosis of cardiac tamponade. Am Heart J. 1999;138:759–64.CrossRefPubMedGoogle Scholar
- 35.• Imazio M, Belli R, Beqaraj F, et al. DRainage Or Pericardiocentesis alone for recurrent nonmalignant, nonbacterial pericardial effusions requiring intervention: rationale and design of the DROP trial, a randomized, open-label, multicenter study. J Cardiovasc Med. 2014;15:510–4. Methodology of a multicenter trial that is randomizing patients with hemodynamically significant nonmalignant, nonbacterial pericardial effusions to pericardiocentesis vs. pericardiocentesis plus prolonged drainage. The primary end-points are incidence of recurrent pericardial effusion and the need for additional pericardiocentesis or cardiac surgery at 12 months. CrossRefGoogle Scholar
- 36.Ziskind AA, Pearce AC, Lemmon CC, Burstein S, Gimple LW, Herrmann HC, et al. Percutaneous balloon pericardiotomy for the treatment of cardiac tamponade and large pericardial effusions: description of technique and report of the first 50 cases. J Am Coll Cardiol. 1993;21:1–5.CrossRefPubMedGoogle Scholar
- 38.• Frohlich GM, Keller P, Schmid F, et al. Haemodynamically irrelevant pericardial effusion is associated with increased mortality in patients with chronic heart failure. Eur Heart J. 2013;34:1414–23. In this retrospective observational study of nearly 900 patients with heart failure, the presence of a hemodynamically insignificant pericardial effusion was independently associated with a ~ 2-fold hazard of death at one year. CrossRefPubMedGoogle Scholar