Ahluwalia M, O'Quinn R, Ky B, Callans D, Kucharczuk J, Carver J R
Department of Medicine, University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 100 Centrex, Philadelphia, PA, 19104, USA.
Department of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Cardiooncology. 2016 Jul 14;2(1):6. doi: 10.1186/s40959-016-0015-1.
Electrocardiographic changes may manifest in patients with pericardial effusions. PR segment changes are frequently overlooked, but when present, can provide diagnostic significance. The diagnostic value of PR segment changes in determining benign versus malignant pericardial disease in cancer patients with pericardial effusions has not been investigated. We aimed to determine the relationship between PR segment changes and malignant pericardial disease in cancer patients presenting with pericardial effusions.
Consecutive patients with active malignancy who underwent surgical subxiphoid pericardial window by a single thoracic surgeon between 2011 and 2014 were included in this study. A total of 104 pre- and post-operative ECGs were reviewed, and PR depression or elevation was defined by deviation of at least 0.5 millivolts from the TP segment using a magnifying glass. Pericardial fluid cytology, flow cytometry and tissue biopsy were evaluated. Baseline characteristics and co-morbidities were compared between cancer patients with benign and malignant pericardial effusions.
A total of 26 patients with active malignancy and pericardial effusion who underwent pericardial window over the study period were included. Eighteen (69 %) patients had isoelectric PR segments, of whom none (0 %) had evidence of malignant pericardial disease (100 % negative predictive value). Eight (31 %) patients had significant ECG findings (PR segment depression in leads II, III and/or aVF as well as PR elevation in aVR/V1), all 8 (100 %) of whom had pathologically confirmed malignant pericardial disease (100 % positive predictive value). PR segment changes in all 8 patients persisted (up to 11 months) on post-operative serial ECGs. The PR segment changes had no relationship to heart rate or the time of atrial-ventricular conduction.
In patients with active cancer presenting with pericardial effusion, the presence of PR segment changes is highly predictive of active malignant pericardial disease. When present, PR changes typically persist on serial ECGs even after pericardial window.
心包积液患者可能出现心电图改变。PR段改变常被忽视，但一旦出现，可能具有诊断意义。PR段改变在癌症合并心包积液患者中鉴别良性与恶性心包疾病的诊断价值尚未得到研究。我们旨在确定癌症合并心包积液患者PR段改变与恶性心包疾病之间的关系。
纳入2011年至2014年间由一名胸外科医生连续进行剑突下心包开窗手术的活动性恶性肿瘤患者。共回顾了104份术前和术后心电图，使用放大镜将PR段压低或抬高定义为相对于TP段至少偏离0.5毫伏。评估心包液细胞学、流式细胞术和组织活检结果。比较良性和恶性心包积液癌症患者的基线特征和合并症。
在研究期间，共有26例活动性恶性肿瘤合并心包积液患者接受了心包开窗手术。18例（69%）患者PR段等电位，其中无一例（0%）有恶性心包疾病证据（阴性预测值100%）。8例（31%）患者有明显心电图表现（II、III和/或aVF导联PR段压低以及aVR/V1导联PR段抬高），所有8例（100%）均经病理证实为恶性心包疾病（阳性预测值100%）。所有8例患者的PR段改变在术后系列心电图中持续存在（长达11个月）。PR段改变与心率或房室传导时间无关。
在合并心包积液的活动性癌症患者中，PR段改变的存在高度提示活动性恶性心包疾病。一旦出现，即使在心包开窗术后，PR改变通常仍会持续存在于系列心电图中。
