Sánchez-Enrique Cristina, Nuñez-Gil Iván J, Viana-Tejedor Ana, De Agustín Alberto, Vivas David, Palacios-Rubio Julián, Vilchez Jean Paul, Cecconi Alberto, Macaya Carlos, Fernández-Ortiz Antonio
Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain.
Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain.
Am J Cardiol. 2016 Feb 15;117(4):664-669. doi: 10.1016/j.amjcard.2015.11.023. Epub 2015 Dec 7.
Cardiac tamponade is a life-threatening condition, whose current specific cause and outcome are unknown. Our purpose was to analyze it. We performed a retrospective observational study with prospective follow-up data including 136 consecutive patients admitted with diagnosis of cardiac tamponade, from 2003 to 2013. We thoroughly recorded variables as clinical features, drainage/pericardiocentesis, fluid characteristics, and long-term events (new cardiac tamponade ± death). The median age was 65 ± 17 years (55% men). In the baseline characteristics, 70% were no smokers, 12% were on anticoagulation, and 13 had suffered a previous myocardial infarction. In the preceding month, 15 patients had undergone a cardiac catheterization, 5 cardiac surgery, and 5 pacemaker insertion. Fever was observed in 16% of patients and 21% displayed other inflammatory symptoms. In 81% of patients, pericardiocentesis was needed. The fluid was hemorrhagic or a transudate in the majority, with positive cytology in 15% and bacteria in 3.7%. Main causes were malignancy (32%), infection (24%), idiopathic (16%), iatrogenic (15%), postmyocardial infarction (7%), uremic (4%), and other causes (2%). After a maximum follow-up of 10.4 years, cardiac tamponade recurred in 10% of the cases (62% in the neoplastic group) and the 48% of patients died (89% in the neoplastic cohort). In conclusion, most cardiac tamponades are due to malignancy, having this specific cause a poorer outcome, probably as a manifestation of an advanced disease. The rest of causes, after an aggressive intensive management, have a good prognosis, especially the iatrogenic.
心脏压塞是一种危及生命的疾病，其目前的具体病因和预后尚不清楚。我们的目的是对其进行分析。我们进行了一项回顾性观察研究，并收集了前瞻性随访数据，研究对象为2003年至2013年期间连续收治的136例诊断为心脏压塞的患者。我们详细记录了临床特征、引流/心包穿刺、液体特征以及长期事件（新发心脏压塞±死亡）等变量。患者的中位年龄为65±17岁（男性占55%）。在基线特征方面，70%的患者不吸烟，12%的患者正在接受抗凝治疗，13例患者曾发生过心肌梗死。在前一个月，15例患者接受了心导管检查，5例接受了心脏手术，5例进行了起搏器植入。16%的患者出现发热，21%的患者表现出其他炎症症状。81%的患者需要进行心包穿刺。大多数患者的液体为血性或漏出液，15%的患者细胞学检查呈阳性，3.7%的患者液体中发现细菌。主要病因包括恶性肿瘤（32%）、感染（24%）、特发性（16%）、医源性（15%）、心肌梗死后（7%）、尿毒症性（4%）以及其他原因（2%）。在最长10.4年的随访期后，10%的病例复发心脏压塞（肿瘤组为62%），48%的患者死亡（肿瘤队列中为89%）。总之，大多数心脏压塞是由恶性肿瘤引起的，这种特定病因的预后较差，可能是晚期疾病的一种表现。其余病因经过积极的强化治疗后，预后良好，尤其是医源性病因。
