Abstract
Background
The purpose of the present study is to evaluate current echocardiographically (echo)-guided pericardiocentesis practice with regard to procedural success, complication rate, etiological causes, and outcomes of patients with clinically significant pericardial effusion.
Patients and methods
Patients who underwent echo-guided pericardiocentesis between January 2004 and February 2014 were identified using an institutional code for the procedure. Other complementary data were obtained by interviewing patients or their relatives (directly or by telephone) and by searching the social security death index.
Results
A total of 301 patients were identified. The pericardium was approached via the subcostal (85 %) or apical (15 %) route under echo guidance in all procedures. The success rate was 97 %, with an intervention-requiring complication rate of 1.3 %. No patient died from complications. The most common etiology was malignancy (n = 84, 28 %). Patients were followed-up for a median of 35 months. Median survival for patients with malignant effusion was 5.9 months compared with 54 months for those with nonmalignant effusion.
Conclusions
Echo-guided pericardiocentesis has a high success and low complication rate in current practice. Among etiologies, malignancy remains the most common cause of clinically significant pericardial effusion and is associated with a poor prognosis.
Zusammenfassung
Hintergrund
Ziel der vorliegenden Studie war die Beurteilung des derzeitigen Untersuchungsablaufs bei echokardiographisch kontrollierter Perikardiozentese im Hinblick auf den Erfolg des Verfahrens, die Komplikationsrate, ätiologische Aspekte und Ergebnisse bei Patienten mit klinisch signifikantem Perikarderguss.
Patienten und Methoden
Die Patienten, bei denen zwischen Januar 2004 und Februar 2014 eine echokardiographisch kontrollierte Perikardiozentese durchgeführt worden war, wurden anhand eines einrichtungsbezogenen Codes für dieses Verfahren ermittelt. Weitere ergänzende Daten wurden durch Befragung der Patienten oder ihrer Angehörigen (direkt oder telefonisch) und mithilfe des Sozialversicherungssterbeindex gewonnen.
Ergebnisse
Insgesamt wurden 301 Patienten ermittelt. Der Zugang zum Perikard erfolgte subkostal (85 %) oder apikal (15 %) unter echokardiographischer Kontrolle aller Untersuchungen. Die Erfolgsrate betrug 97 %, dabei lag die eine Intervention erfordernde Komplikationsrate bei 1,3 %. Es starb kein Patient an Komplikationen. Die häufigste Ätiologie war ein Malignom (n = 84; 28 %). Im Mittel wurden die Patienten 35 Monate lang nachbeobachtet. Das durchschnittliche Überleben lag für Patienten mit einem malignen Perikarderguss bei 5,9 Monaten im Gegensatz zu 54 Monaten für Personen mit nichtmalignem Erguss.
Schlussfolgerung
Die echokardiographisch kontrollierte Perikardiozentese weist eine hohe Erfolgs- und niedrige Komplikationsrate bei dem derzeitigen Untersuchungsablauf auf. Ätiologisch liegt einem klinisch signifikanten Perikarderguss zumeist ein Malignom zugrunde, das mit einer schlechten Prognose einhergeht.
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Acknowledgments
We thank Prof. Erdem Kasikcioglu, MD, for his review of the manuscript.
Compliance with ethical guidelines
Conflict of interest. S. Akyuz, A. Zengin, E. Arugaslan, S. Yazici, T. Onuk, U.S. Ceylan, B. Gungor, U. Gurkan, T. Kemaloglu Oz, H. Kasikcioglu, and N. Cam state that there are no conflicts of interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.
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Akyuz, S., Zengin, A., Arugaslan, E. et al. Echo-guided pericardiocentesis in patients with clinically significant pericardial effusion . Herz 40 (Suppl 2), 153–159 (2015). https://doi.org/10.1007/s00059-014-4187-x
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DOI: https://doi.org/10.1007/s00059-014-4187-x