Effusive-Constrictive Pericarditis After Pericardiocentesis: Incidence, Associated Findings, and Natural History

• Published in: JACC. Cardiovascular imaging 2018-04, Vol.11 (4), p.534-541
• Main Authors: Kim, Kye Hun, Miranda, William R, Sinak, Larry J, Syed, Faisal F, Melduni, Rowlens M, Espinosa, Raul E, Kane, Garvan C, Oh, Jae K
• Format: Article
• Language: English
• Subjects: Aged; Anti-Inflammatory Agents - therapeutic use; Echocardiography, Doppler; Female; Hemodynamics; Humans; Incidence; Male; Middle Aged; Minnesota - epidemiology; Pericardial Effusion - diagnostic imaging; Pericardial Effusion - epidemiology; Pericardial Effusion - physiopathology; Pericardial Effusion - therapy; Pericardiectomy; Pericardiocentesis - adverse effects; Pericarditis, Constrictive - diagnostic imaging; Pericarditis, Constrictive - epidemiology; Pericarditis, Constrictive - physiopathology; Pericarditis, Constrictive - therapy; Prognosis; Retrospective Studies; Time Factors; Ventricular Function, Left
• ISSN: 1936-878X; 1876-7591
• DOI: 10.1016/j.jcmg.2017.06.017

This study sought to investigate the incidence, associated findings, and natural history of effusive-constrictive pericarditis (ECP) after pericardiocentesis. ECP is characterized by the coexistence of tense pericardial effusion and constriction of the heart by the visceral pericardium. Echocardiography is currently the main diagnostic tool in the assessment of pericardial disease, but limited data have been published on the incidence and prognosis of ECP diagnosed by echo-Doppler. A total of 205 consecutive patients undergoing pericardiocentesis at Mayo Clinic, Rochester, Minnesota, were divided into 2 groups (ECP and non-ECP) based on the presence or absence of post-centesis echocardiographic findings of constrictive pericarditis. Clinical, laboratory, and imaging characteristics were compared. ECP was subsequently diagnosed in 33 patients (16%) after pericardiocentesis. Overt clinical cardiac tamponade was present in 52% of ECP patients and 36% of non-ECP patients (p = 0.08). Post-procedure hemopericardium was more frequent in the ECP group (33% vs. 13%; p = 0.003), and a higher percentage of neutrophils and lower percentage of monocytes were noted on pericardial fluid analysis in those patients. Clinical and laboratory findings were otherwise similar. Baseline early diastolic mitral septal annular velocity was significantly higher in the ECP group. Before pericardiocentesis, respiratory variation of mitral inflow velocity, expiratory diastolic flow reversal of hepatic vein, and respirophasic septal shift were significantly more frequent in the ECP group. Fibrinous or loculated effusions were also more frequently observed in the ECP group. Four deaths occurred in the ECP group; all 4 patients had known malignancies. During median follow-up of 3.8 years (interquartile range: 0.5 to 8.3 years), only 2 patients required pericardiectomy for persistent constrictive features and symptoms. In a large cohort of unselected patients undergoing pericardiocentesis, 16% were found to have ECP. Pre-centesis echocardiographic findings might identify such patients. Long-term prognosis in those patients remains good, and pericardiectomy was rarely required.