Shaik Nafeez Javed, Hegde Sindhu Sujeeth, Seshadri Shubha, Cherukuri Mounika
Department of General Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
Faculty of General Medicine, Department of General Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
BMC Cardiovasc Disord. 2024 Dec 19;24(1):714. doi: 10.1186/s12872-024-04381-1.
Pericardial effusion (PE) indicates the build-up of fluid within the pericardial sac, which encases the heart. The present study was undertaken to assess the clinical profile, etiology of pericardial effusion and to determine the correlation of cardiac tamponade and constrictive pericarditis with etiology.
A prospective observational hospital based longitudinal study was undertaken among the 88 newly diagnosed and known patients of pericardial effusion who are above 18 years. The clinical profile of pericardial effusion including history, examination, standard lab parameters routinely done including thyroid function tests, HIV Serology, ECG, Echocardiography and imaging if done (HRCT thorax), pericardial fluid analysis (if performed) were elicited.
Majority of the patients were males (55.7%), with a mean age of 51.3 years. Among the 88 patients of pericardial effusion, 20 had cardiac tamponade, 13 individuals were diagnosed with constrictive pericarditis. Dyspnea was the most common presenting complaint (65.9%). Chronic kidney disease / uremia is the most common cause of pericardial effusion accounting for 25%, followed by neoplastic (20.5%) and tuberculosis (17%). While in cardiac tamponade patients neoplasm followed by tuberculosis were the most common etiology, patients with constrictive pericarditis had tuberculosis followed by chronic kidney disease as the most common etiology. Echocardiography features were not significantly different according to the etiology of the pericardial effusion (p > 0.05). Thickened pericardium found in the echocardiography showed maximum specificity (76.9%), while thickened fluid/exudates showed maximum sensitivity (65.2%) and negative predictive value (77.1%) for tuberculous pericardial effusion.
Chronic kidney disease, closely followed by infections (mostly tuberculosis), are the frequent causes of PE in the present settings. Breathlessness is the most frequent clinical feature in the patients of PE. Fibrin strands, thickened pericardium, thickened fluid in Echocardiography assists in diagnosing tubercular pericardial effusion. Cardiomegaly in chest X-ray or CT scans should further prompt towards diagnosing pericardial effusion. It is essential to incorporate these findings into the clinical practice, by evaluating the patients presenting with breathlessness for PE. CKD needs to be placed on par with tuberculosis while suspecting the etiology of the PE in the present settings. ADA levels in pericardial fluid (> 40) can be considered as a specific marker for tubercular PE.
心包积液（PE）指的心包腔内液体的积聚，心包包裹着心脏。本研究旨在评估心包积液的临床特征、病因，并确定心脏压塞和缩窄性心包炎与病因之间的相关性。
对88例年龄在18岁以上新诊断及已知的心包积液患者进行了一项基于医院的前瞻性观察性纵向研究。收集心包积液的临床特征，包括病史、检查、常规进行的标准实验室参数，如甲状腺功能测试、HIV血清学、心电图、超声心动图以及影像学检查（如胸部高分辨率CT），如有进行心包积液分析也一并收集。
大多数患者为男性（55.7%），平均年龄为51.3岁。在88例心包积液患者中，20例发生心脏压塞，13例被诊断为缩窄性心包炎。呼吸困难是最常见的主诉（65.9%）。慢性肾脏病/尿毒症是心包积液最常见的原因，占25%，其次是肿瘤（20.5%）和结核（17%）。在心脏压塞患者中，肿瘤其次是结核是最常见的病因，而缩窄性心包炎患者中，结核其次是慢性肾脏病是最常见的病因。根据心包积液的病因，超声心动图特征无显著差异（p>0.05）。超声心动图中发现的心包增厚显示出最大特异性（76.9%），而液体/渗出物增厚对结核性心包积液显示出最大敏感性（65.2%）和阴性预测值（77.1%）。
在当前环境下，慢性肾脏病紧随感染（主要是结核）之后，是心包积液的常见原因。呼吸困难是心包积液患者最常见的临床特征。超声心动图中的纤维条索、心包增厚、液体增厚有助于诊断结核性心包积液。胸部X线或CT扫描中的心脏增大应进一步提示心包积液的诊断。通过评估出现呼吸困难的患者是否存在心包积液，将这些发现纳入临床实践至关重要。在当前环境下怀疑心包积液病因时，慢性肾脏病应与结核同等对待。心包积液中ADA水平（>40）可被视为结核性心包积液的特异性标志物。
