Conference: 2010 International PHA Conference and Scientific Sessions
Release Date: 06.22.2010
Presentation Type: Scientific Sessions
Fenstad E, Le R, Sinak L, Maradit-Kremers H, Ammash N, Villarraga H, Oh J, Frantz R, McCully R, McGoon M, Kane G.
Mayo Clinic Division of Cardiovascular Disease, Department of Internal Medicine, Rochester, MN, USA
BACKGROUND. Reports to date have suggested that pericardial effusion is an uncommon and unfavorable sign in patients with Pulmonary Arterial Hypertension. The long-term significance of effusion size and patient characteristics remain unclear and the safety of pericardiocentesis in this patient population has been questioned.
METHODS. Single center cohort study of all patients first seen with group 1 PAH at a specialty PH center between 1995 & 2006. All patients had echocardiograms. Pericardiocentesis was performed under echocardiographic guidance with moderate conscious sedation in a monitored inpatient setting for those who received intervention.
RESULTS. Of 577 patients, 26% (150 patients) had pericardial effusion on echocardiography. The majority of effusions (128 of 150) were small (<1 cm in size). Moderate or greater effusions were present in 22 patients (9.3%) with evidence of hemodynamic compromise in 14 patients requiring pericardiocentesis. After adjusting for age, sex, functional class, and six minute walk distance, two factors independently associated with the presence of pericardial effusion were collagen vascular disease (OR 3.71; 2.05, 6.87) and right atrial pressure (OR 1.83 per 5 mm Hg; 1.33, 2.54). Median survival for patients with moderate effusion, mild effusion, and no effusion was 12 months, 36 months, and 69 months respectively (p<0.001). The degree of the pericardial effusion was most predictive of poor outcome in patients with collagen vascular disease associated PAH. Twelve of 14 patients undergoing pericardiocentesis had collagen vascular disease. Treated pericardial effusions were large (832 ± 512) and generally serious. Survival at 48 hours was 100% and associated with clinical improvement in 13/14. Repeat pericardiocentesis was required in three patients.
CONCLUSIONS. The incidence of any pericardial effusion on echocardiogram is low in patients with PAH. Effusions are typically small, occur in the setting of connective tissue disease, and are associated with elevated right atrial pressure. However, even small pericardial effusions are independently associated with poor survival. Rarely do pericardial effusions cause tamponade but when present can be safely drained with echo-guided pericardiocentesis in a monitored inpatient setting.