Department of Cardiology, Belgrade University School of Medicine and Clinical Center of Serbia, Koste Todorovića 8, 11000, Belgrade, Serbia.
Heart Fail Rev. 2013 May;18(3):307-16. doi: 10.1007/s10741-012-9326-y.
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.
心外膜晕圈在心导管术中勾勒出心脏阴影。为了确定该征象是否适用于心包穿刺引导，三位研究者在心包穿刺或心导管术前行后前位（PA）和侧位透视时，将其强度评估为无（=0 级）、不明显（=0.5 级）、清晰（=1 级）和强烈（=2 级）。三个研究人群包括：（a）32 例心包积液（PE）患者（PE 组），男性占 53.1%，年龄为 53.9±13.9 岁；（b）14 例心肌炎（PM）患者（PM 组），男性占 64.3%，年龄为 51.6±14.4 岁；和（c）46 例冠心病（CAD）患者（CAD 组），无 PE，男性占 95.6%，年龄为 67.3±11.8 岁。PE 患者的心外膜晕圈现象强度最高，CAD 患者最低，PM 患者居中（PA/侧位透视中等级总和中位数：4/5 与 2/2.5 与 3/3）（p<0.01）。该现象在两个血管造影视图中与 HR 和超声心动图 PE 大小密切相关。与 BMI 和年龄的相关性仅在侧位透视中具有统计学意义，与 PE 体积的相关性仅在 PA 视图中具有统计学意义。PA 视图中该征象对 PE 的敏感性为 84.1%，侧位视图中为 92.0%。在 10/32 例 PE 患者中，对该征象进行了重复评估，发现 PA 和侧位透视中的等级均降低（p<0.01）。总之，心外膜晕圈征象对 PE 的检测具有高度敏感性；它在至少一个血管造影投影中与 PE 体积、HR、年龄、BMI 和超声心动图中的 PE 大小密切相关，因此可作为心包穿刺的安全引导。
