Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
JACC Cardiovasc Imaging. 2018 Apr;11(4):534-541. doi: 10.1016/j.jcmg.2017.06.017. Epub 2017 Oct 5.
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.
本研究旨在探讨心包穿刺后渗出性缩窄性心包炎（ECP）的发生率、相关表现和自然病史。
ECP 的特征是心包腔内存在紧张的积液，同时心脏被内脏心包所限制。超声心动图是目前评估心包疾病的主要诊断工具，但关于经超声心动图-多普勒诊断的 ECP 发生率和预后的数据有限。
明尼苏达州罗切斯特市梅奥诊所的 205 例连续心包穿刺患者，根据心包穿刺后是否存在缩窄性心包炎的超声心动图表现，分为 ECP 组和非 ECP 组。比较两组的临床、实验室和影像学特征。
心包穿刺后，33 例（16%）患者被诊断为 ECP。ECP 组中有 52%的患者出现明显的临床心脏压塞，而非 ECP 组中有 36%的患者出现（p=0.08）。ECP 组的心包积血更为常见（33% vs. 13%；p=0.003），心包积液分析中中性粒细胞比例较高，单核细胞比例较低。其他临床和实验室检查结果相似。ECP 组舒张早期二尖瓣环速度明显较高。心包穿刺前，ECP 组的二尖瓣流入速度呼吸变异、肝静脉呼气期舒张期血流逆转和呼吸性室间隔移位更为频繁。ECP 组也更常出现纤维蛋白性或分隔性积液。ECP 组有 4 例死亡，均为已知恶性肿瘤。在中位随访 3.8 年（四分位距：0.5 至 8.3 年）期间，仅 2 例因持续缩窄性特征和症状而行心包切除术。
在接受心包穿刺的大量未选择患者中，有 16%的患者被发现患有 ECP。心包穿刺前的超声心动图表现可能有助于识别此类患者。这些患者的长期预后良好，很少需要心包切除术。
