Akao Kousuke, Imamura Teruhiko, Kinugawa Koichiro
Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama 930-0194, Japan.
J Clin Med. 2024 Apr 30;13(9):2644. doi: 10.3390/jcm13092644.
Significant pericardial effusion requires percutaneous drainage. Some patients experience recurrent pericardial effusion following index drainage, but its risk factors remain unknown. Such knowledge should further improve the clinical management of individuals presenting with pericardial effusion for risk stratification and the construction of therapeutic and management strategies beforehand. Patients who underwent percutaneous drainage for pericardial effusion between 2018 and 2023 were retrospectively included and were followed for 2 years or until November 2023. Baseline factors associated with recurrent pericardial effusion that required percutaneous drainage again were investigated to identify the high-risk cohort. A total of 39 patients (83 years on median, 28 males) were included. During the 2-year observation period, 11 patients had the primary outcome. The left ventricular end-diastolic diameter at baseline was independently associated with the primary outcome with an adjusted hazard ratio of 0.88 (95% confidence interval 0.80-0.97, = 0.013) with a cutoff of 42 mm, which significantly stratified the cumulative incidence of the primary outcome (53% versus 10%, = 0.011). Recurrent pericardial effusion after percutaneous drainage is not a rare phenomenon. A smaller left ventricular endo-diastolic diameter was an independent risk factor for recurrent pericardial effusion. The clinical implications of our findings in daily clinical practice should be validated in future prospective studies. Further studies are warranted to clarify the underlying causality between them.
大量心包积液需要进行经皮引流。一些患者在首次引流后会出现复发性心包积液，但其危险因素尚不清楚。掌握这些知识应能进一步改善心包积液患者的临床管理，以便进行风险分层并预先制定治疗和管理策略。回顾性纳入了2018年至2023年间因心包积液接受经皮引流的患者，并随访2年或至2023年11月。研究与再次需要经皮引流的复发性心包积液相关的基线因素，以确定高危人群。共纳入39例患者（中位年龄83岁，男性28例）。在2年观察期内，11例患者出现主要结局。基线时的左心室舒张末期内径与主要结局独立相关，调整后的风险比为0.88（95%置信区间0.80-0.97，P = 0.013），截断值为42 mm，这显著分层了主要结局的累积发生率（53%对10%，P = 0.011）。经皮引流后复发性心包积液并非罕见现象。较小的左心室舒张末期内径是复发性心包积液的独立危险因素。我们研究结果在日常临床实践中的临床意义应在未来的前瞻性研究中得到验证。有必要进一步研究以阐明它们之间的潜在因果关系。
