Park Hyukjin, Yoon Hyun Ju, Lee Nuri, Kim Jong Yoon, Kim Hyung Yoon, Cho Jae Yeong, Kim Kye Hun, Ahn Youngkeun, Jeong Myung Ho, Cho Jeong Gwan
Department of Cardiology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
Department of Cardiology, Chonnam National University School/Hospital, Gwangju, Korea.
Korean Circ J. 2022 Jan;52(1):74-83. doi: 10.4070/kcj.2021.0217. Epub 2021 Nov 1.
This study aimed to identify the characteristics and clinical outcomes of cancer patients who developed constrictive physiology (CP) after percutaneous pericardiocentesis.
One-hundred thirty-three cancer patients who underwent pericardiocentesis were divided into 2 groups according to follow-up echocardiography (CP vs. non-CP). The clinical history, imaging findings, and laboratory results, and overall survival were compared.
CP developed in 49 (36.8%) patients after pericardiocentesis. The CP group had a more frequent history of radiation therapy. Pericardial enhancement and malignant masses abutting the pericardium were more frequently observed in the CP group. Fever and ST segment elevation were more frequent in the CP group, with higher C-reactive protein levels (6.6±4.3mg/dL vs. 3.3±2.5mg/dL, p<0.001). Pericardial fluid leukocytes counts were significantly higher, and positive cytology was more frequent in the CP group. In baseline echocardiography before pericardiocentesis, medial e' velocity was significantly higher in the CP group (8.6±2.1cm/s vs. 6.5±2.3cm/s, p<0.001), and respirophasic ventricular septal shift, prominent expiratory hepatic venous flow reversal, pericardial adhesion, and loculated pericardial fluid were also more frequent. The risk of all-cause death was significantly high in the CP group (hazard ratio, 1.53; 95% confidence interval,1.10-2.13; p=0.005).
CP frequently develops after pericardiocentesis, and it is associated with poor survival in cancer patients. Several clinical signs, imaging, and laboratory findings suggestive of pericardial inflammation and/or direct malignant pericardial invasion are frequently observed and could be used as predictors of CP development.
本研究旨在确定经皮心包穿刺术后发生缩窄性生理改变（CP）的癌症患者的特征及临床结局。
133例行心包穿刺术的癌症患者根据随访超声心动图结果分为两组（CP组与非CP组）。比较两组的临床病史、影像学表现、实验室检查结果及总生存期。
49例（36.8%）患者心包穿刺术后发生CP。CP组放疗史更常见。CP组心包增厚及心包旁恶性肿块更常见。CP组发热及ST段抬高更常见，C反应蛋白水平更高（6.6±4.3mg/dL对3.3±2.5mg/dL，p<0.001）。CP组心包积液白细胞计数显著更高，阳性细胞学检查更常见。心包穿刺术前的基线超声心动图检查显示，CP组的e'峰速度显著更高（8.6±2.1cm/s对6.5±2.3cm/s，p<0.001），呼吸相室间隔移位、明显的呼气期肝静脉血流逆转、心包粘连及局限性心包积液也更常见。CP组全因死亡风险显著更高（风险比，1.53；95%置信区间，1.10 - 2.13；p = 0.005）。
CP在心包穿刺术后频繁发生，且与癌症患者的不良生存相关。经常观察到一些提示心包炎症和/或直接恶性心包侵犯的临床体征、影像学及实验室检查结果，可作为CP发生的预测指标。
