Clinical research – pulmonary hypertensionIncidence and Significance of Pericardial Effusion in Patients With Pulmonary Arterial Hypertension
Section snippets
Methods
The medical records were retrospectively reviewed for consecutive patients aged ≥18 years evaluated for PAH (World Health Organization [WHO] class I) at a university-based referral centre for pulmonary vascular disease between January 1990 and May 2010. Patients were diagnosed as having PAH according to current Dana Point clinical classification.1, 2 Some patients were evaluated prior to the publication of the present criteria for PAH, however these patients' diagnoses were adjusted to
Results
We reviewed the medical records of 162 consecutive patients evaluated for PAH during the study period. In 8 patients there was no baseline echocardiogram available within the 6-month window around the index date and these patients were not included in our study. Consequently, echocardiographic findings were available for 154 patients (95.1%), 83.8% of whom were female, with a mean age of 54.3 ± 15.6 years.
Discussion
The present study is the first to establish the incidence of new PEF among PAH patients followed longitudinally with serial echocardiograms, and it provides novel information about the prognostic significance of PEF appearance. We were also able to characterize PAH patients who develop PEF during follow-up. We show that PEFs frequently accumulate in patients with PAH. Our findings indicate that PAH patients who develop PEF have no differences with respect to baseline characteristics, associated
Funding Sources
This study was supported in part by the Bank of Montreal Center for the Study of Heart Disease in Women at the Jewish General Hospital. Dr Shimony was supported by the Azrieli Foundation and by a Susan Raymer Cardiology Fellowship Grant. Dr Fox was supported in part by the William Pencer Family Foundation.
Disclosures
The authors have no conflicts of interest to disclose.
Acknowledgements
The authors thank the physicians and sonographers of the Cardiac Ultrasound Laboratory for their diligence and skill in performing the echocardiograms over the years.
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Cited by (45)
Prognostic Value of Echocardiographic Variables Prior to and Following Initiation of Parenteral Prostacyclin Therapy: An Observational Study
2022, ChestCitation Excerpt :The presence and size of a pericardial effusion also did not correlate with elevated RA pressures at follow-up, unusual in that this is believed to be one of the primary mechanisms in the development of PAH effusions.34 A lack of improvement in the severity or frequency of pericardial effusions has been seen in other prostacyclin studies: Hinderliter et al35 reported no improvement in pericardial effusion size “score” after 12 weeks of IV epoprostenol therapy, despite significant improvement in other prognostic measures, and Shimony et al36 also found a high rate of new pericardial effusions in patients with PAH following treatment with IV epoprostenol (15 of 23 patients [65%]). These findings raise the question of whether pericardial effusions may develop in prostacyclin-treated patients with PAH through alternative mechanisms beyond worsening hemodynamics and with (potentially) more variable prognostic implications.
Pericardial tamponade: A comprehensive emergency medicine and echocardiography review
2022, American Journal of Emergency MedicineCitation Excerpt :The RV will be less likely to demonstrate diastolic collapse (and thus, tamponade physiology) in the presence of a higher baseline intrapericardial pressure (Video 6). This would be the case for cor pulmonale and pulmonary hypertension (PH) (in whom 30% of patients develop a pericardial effusion [89,90]), severe left ventricular failure, or other etiologies of right ventricular hypertrophy [58,82,83,91-96]. Alternatively, right ventricular collapse will occur more readily if the chamber’s intracardiac pressures are lower, such as with hypovolemia [80,94,95].
A Simplified Diagnostic and Therapeutic Approach to Pulmonary Hypertension
2022, Current Problems in CardiologyThe Relationship of Pleural and Pericardial Effusion With Pulmonary Hemodynamics in Patients With Pulmonary Hypertension
2021, American Journal of the Medical SciencesCitation Excerpt :Interpreting prior studies on the frequency of pleural effusions in PH in this manner, the pleural effusion may simply act as a marker for decompensated RHF once PVH and other causes of pleural effusion have been excluded. Pericardial effusion occurs commonly in patients with PH, and its prevalence has been reported anywhere from 16 to 65% and is associated with increased mortality.9–12 Pericardial effusion is also more common in the presence of connective tissue disease.
Canadian Cardiovascular Society/Canadian Thoracic Society Position Statement on Pulmonary Hypertension
2020, Canadian Journal of CardiologyRelative Importance of Baseline and Longitudinal Evaluation in the Follow-Up of Vasodilator Therapy in Pulmonary Arterial Hypertension
2019, JACC: Cardiovascular ImagingCitation Excerpt :However, because of the vague and nonspecific symptoms of PAH, patients can be diagnosed at any time point in the evolution of RV dysfunction. Pericardial effusion has long been established as a strong outcome marker (15), but because of its association with right heart failure, this signal is of limited value to guide therapy. Markers of RV function may give greater insight into a patient’s current clinical status.
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