Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical College, Albany, NY, USA.
Division of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
Am J Med Sci. 2021 Jun;361(6):731-735. doi: 10.1016/j.amjms.2021.01.003. Epub 2021 Jan 9.
The relationship between the presence of pleural and pericardial effusion in reference to hemodynamic parameters remains unclear in ambulatory patients with pulmonary hypertension (PH).
Consecutive patients who underwent right catheterization (RHC) for the evaluation of pulmonary hypertension were enrolled. Point-of- care ultrasound was performed prior to the RHC to determine the presence of pleural effusion and pericardial effusion. We conducted a cross-sectional study to determine the association between presence of pericardial and pleural effusion with pulmonary hemodynamic variables.
Twenty-five (78.1%) of 32 patients had evidence of PH by RHC. Mean pulmonary artery pressure of the population was 40.6 mmHg, and 68% (17/25) had WHO group I PH. Six (24.0%) of 25 PH patients had pleural effusions identified, of which 4 out of 6 (66.7%) had a pulmonary artery wedge pressure >15 mmHg. Eleven (44.0%) of the 25 PH patients were also found to have pericardial effusions, and most of those patients 10/11(90.9%) had an elevated right atrial pressure >10 mmHg. The presence of a pleural effusion was associated with a pulmonary artery wedge pressure >15 mmHg (p = 0.032) and the presence of a pericardial effusion was associated with a right atrial pressure >10 mmHg (p = 0.004). Detection of pleural effusion had a poor positive predictive value (67%) for the presence of pulmonary venous hypertension, whereas presence of a pericardial effusion was highly predictive (89%) of the presence of systemic venous hypertension.
Systemic venous hypertension was associated with the presence of pericardial effusions, while pulmonary venous hypertension is associated with pleural effusion development in ambulatory patients with pulmonary hypertension.
在门诊肺动脉高压（PH）患者中，胸腔积液和心包积液的存在与血流动力学参数之间的关系尚不清楚。
连续入组因肺动脉高压而行右心导管检查（RHC）的患者。在 RHC 前进行即时超声心动图检查以确定胸腔积液和心包积液的存在。我们进行了一项横断面研究，以确定心包积液和胸腔积液的存在与肺血流动力学变量之间的关系。
32 例患者中 25 例（78.1%）通过 RHC 证实存在 PH。人群的平均肺动脉压为 40.6mmHg，68%（17/25）为 WHO 组 I PH。25 例 PH 患者中有 6 例（24.0%）发现胸腔积液，其中 6 例中有 4 例（66.7%）肺动脉楔压>15mmHg。25 例 PH 患者中有 11 例（44.0%）也发现有心包积液，其中大多数患者 10/11（90.9%）右心房压升高>10mmHg。胸腔积液的存在与肺动脉楔压>15mmHg 相关（p=0.032），心包积液的存在与右心房压>10mmHg 相关（p=0.004）。胸腔积液的存在对肺静脉高压的阳性预测值较低（67%），而心包积液的存在对全身静脉高压的存在具有高度预测性（89%）。
在门诊肺动脉高压患者中，系统性静脉高压与心包积液的存在相关，而肺静脉高压与胸腔积液的发展相关。
