Pericardial effusions in pulmonary arterial hypertension: Characteristics, prognosis, and role of drainage

Eric R. Fenstad, Rachel J. Le, Lawrence J. Sinak, Hilal D Maradit Kremers, Naser M. Ammash, Assefa M. Ayalew, Hector R Vilarraga, Jae Kuen Oh, Robert Frantz, Robert B. McCully, Michael D. McGoon, Garvan M Kane

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background: The presence and size of a pericardial effusion in pulmonary arterial hypertension (PAH) and its association with outcome is unclear. Methods: In this single-center cohort study of 577 patients with group 1 PAH seen between January 1, 1995, and December 31, 2005, all patients underwent transthoracic echocardiography and were followed for ge; 5 years. Echocardiography-guided pericardiocentesis was performed as needed. Results: Pericardial effusions on index echocardiography occurred in 150 patients (26%); 128 patients had small and 22 had moderate-sized or larger effusions. Most of the moderate or greater effusions occurred in patients who had connective tissue disease (82%). Mean right atrial pressure was 13.4 ± 4.4 mm Hg (no effusion), 15.1 ± 4.4 mm Hg (small effusion), and 17.0 ± 4.0 mm Hg (moderate or greater effusion) (P <.0001). Median survival for patients with moderate or greater effusion, mild effusion, or no effusion was 11.3 months, 42.3 months, and 76.5 months, respectively. Four of the 22 patients with moderate or greater pericardial effusions eventually required echocardiography-guided pericardiocentesis because of clinical and echocardiographic evidence of hemodynamic impact. When drained, the effusions were large (858 ± 469 mL) and generally serous. All pericardiocenteses were performed cautiously under echocardiographic guidance by a highly experienced echocardiologist, with low immediate morbidity and mortality. Conclusions: Pericardial effusions are relatively common but rarely of hemodynamic significance in patients with PAH. However, even modest degrees of pericardial fluid are associated with a significant increase in mortality and appear to reflect the presence of associated collagen vascular disease and high right atrial pressure.

Original languageEnglish (US)
Pages (from-to)1530-1538
Number of pages9
JournalChest
Volume144
Issue number5
DOIs
StatePublished - Nov 2013

Fingerprint

Pericardial Effusion
Pulmonary Hypertension
Drainage
Pericardiocentesis
Echocardiography
Atrial Pressure
Hemodynamics
Collagen Diseases
Connective Tissue Diseases
Mortality
Vascular Diseases
Cohort Studies
Morbidity
Survival

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Pericardial effusions in pulmonary arterial hypertension : Characteristics, prognosis, and role of drainage. / Fenstad, Eric R.; Le, Rachel J.; Sinak, Lawrence J.; Maradit Kremers, Hilal D; Ammash, Naser M.; Ayalew, Assefa M.; Vilarraga, Hector R; Oh, Jae Kuen; Frantz, Robert; McCully, Robert B.; McGoon, Michael D.; Kane, Garvan M.

In: Chest, Vol. 144, No. 5, 11.2013, p. 1530-1538.

Research output: Contribution to journalArticle

Fenstad, Eric R. ; Le, Rachel J. ; Sinak, Lawrence J. ; Maradit Kremers, Hilal D ; Ammash, Naser M. ; Ayalew, Assefa M. ; Vilarraga, Hector R ; Oh, Jae Kuen ; Frantz, Robert ; McCully, Robert B. ; McGoon, Michael D. ; Kane, Garvan M. / Pericardial effusions in pulmonary arterial hypertension : Characteristics, prognosis, and role of drainage. In: Chest. 2013 ; Vol. 144, No. 5. pp. 1530-1538.
@article{a88198505b0a4d4f9477bccd850589e7,
title = "Pericardial effusions in pulmonary arterial hypertension: Characteristics, prognosis, and role of drainage",
abstract = "Background: The presence and size of a pericardial effusion in pulmonary arterial hypertension (PAH) and its association with outcome is unclear. Methods: In this single-center cohort study of 577 patients with group 1 PAH seen between January 1, 1995, and December 31, 2005, all patients underwent transthoracic echocardiography and were followed for ge; 5 years. Echocardiography-guided pericardiocentesis was performed as needed. Results: Pericardial effusions on index echocardiography occurred in 150 patients (26{\%}); 128 patients had small and 22 had moderate-sized or larger effusions. Most of the moderate or greater effusions occurred in patients who had connective tissue disease (82{\%}). Mean right atrial pressure was 13.4 ± 4.4 mm Hg (no effusion), 15.1 ± 4.4 mm Hg (small effusion), and 17.0 ± 4.0 mm Hg (moderate or greater effusion) (P <.0001). Median survival for patients with moderate or greater effusion, mild effusion, or no effusion was 11.3 months, 42.3 months, and 76.5 months, respectively. Four of the 22 patients with moderate or greater pericardial effusions eventually required echocardiography-guided pericardiocentesis because of clinical and echocardiographic evidence of hemodynamic impact. When drained, the effusions were large (858 ± 469 mL) and generally serous. All pericardiocenteses were performed cautiously under echocardiographic guidance by a highly experienced echocardiologist, with low immediate morbidity and mortality. Conclusions: Pericardial effusions are relatively common but rarely of hemodynamic significance in patients with PAH. However, even modest degrees of pericardial fluid are associated with a significant increase in mortality and appear to reflect the presence of associated collagen vascular disease and high right atrial pressure.",
author = "Fenstad, {Eric R.} and Le, {Rachel J.} and Sinak, {Lawrence J.} and {Maradit Kremers}, {Hilal D} and Ammash, {Naser M.} and Ayalew, {Assefa M.} and Vilarraga, {Hector R} and Oh, {Jae Kuen} and Robert Frantz and McCully, {Robert B.} and McGoon, {Michael D.} and Kane, {Garvan M}",
year = "2013",
month = "11",
doi = "10.1378/chest.12-3033",
language = "English (US)",
volume = "144",
pages = "1530--1538",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "5",

}

TY - JOUR

T1 - Pericardial effusions in pulmonary arterial hypertension

T2 - Characteristics, prognosis, and role of drainage

AU - Fenstad, Eric R.

AU - Le, Rachel J.

AU - Sinak, Lawrence J.

AU - Maradit Kremers, Hilal D

AU - Ammash, Naser M.

AU - Ayalew, Assefa M.

AU - Vilarraga, Hector R

AU - Oh, Jae Kuen

AU - Frantz, Robert

AU - McCully, Robert B.

AU - McGoon, Michael D.

AU - Kane, Garvan M

PY - 2013/11

Y1 - 2013/11

N2 - Background: The presence and size of a pericardial effusion in pulmonary arterial hypertension (PAH) and its association with outcome is unclear. Methods: In this single-center cohort study of 577 patients with group 1 PAH seen between January 1, 1995, and December 31, 2005, all patients underwent transthoracic echocardiography and were followed for ge; 5 years. Echocardiography-guided pericardiocentesis was performed as needed. Results: Pericardial effusions on index echocardiography occurred in 150 patients (26%); 128 patients had small and 22 had moderate-sized or larger effusions. Most of the moderate or greater effusions occurred in patients who had connective tissue disease (82%). Mean right atrial pressure was 13.4 ± 4.4 mm Hg (no effusion), 15.1 ± 4.4 mm Hg (small effusion), and 17.0 ± 4.0 mm Hg (moderate or greater effusion) (P <.0001). Median survival for patients with moderate or greater effusion, mild effusion, or no effusion was 11.3 months, 42.3 months, and 76.5 months, respectively. Four of the 22 patients with moderate or greater pericardial effusions eventually required echocardiography-guided pericardiocentesis because of clinical and echocardiographic evidence of hemodynamic impact. When drained, the effusions were large (858 ± 469 mL) and generally serous. All pericardiocenteses were performed cautiously under echocardiographic guidance by a highly experienced echocardiologist, with low immediate morbidity and mortality. Conclusions: Pericardial effusions are relatively common but rarely of hemodynamic significance in patients with PAH. However, even modest degrees of pericardial fluid are associated with a significant increase in mortality and appear to reflect the presence of associated collagen vascular disease and high right atrial pressure.

AB - Background: The presence and size of a pericardial effusion in pulmonary arterial hypertension (PAH) and its association with outcome is unclear. Methods: In this single-center cohort study of 577 patients with group 1 PAH seen between January 1, 1995, and December 31, 2005, all patients underwent transthoracic echocardiography and were followed for ge; 5 years. Echocardiography-guided pericardiocentesis was performed as needed. Results: Pericardial effusions on index echocardiography occurred in 150 patients (26%); 128 patients had small and 22 had moderate-sized or larger effusions. Most of the moderate or greater effusions occurred in patients who had connective tissue disease (82%). Mean right atrial pressure was 13.4 ± 4.4 mm Hg (no effusion), 15.1 ± 4.4 mm Hg (small effusion), and 17.0 ± 4.0 mm Hg (moderate or greater effusion) (P <.0001). Median survival for patients with moderate or greater effusion, mild effusion, or no effusion was 11.3 months, 42.3 months, and 76.5 months, respectively. Four of the 22 patients with moderate or greater pericardial effusions eventually required echocardiography-guided pericardiocentesis because of clinical and echocardiographic evidence of hemodynamic impact. When drained, the effusions were large (858 ± 469 mL) and generally serous. All pericardiocenteses were performed cautiously under echocardiographic guidance by a highly experienced echocardiologist, with low immediate morbidity and mortality. Conclusions: Pericardial effusions are relatively common but rarely of hemodynamic significance in patients with PAH. However, even modest degrees of pericardial fluid are associated with a significant increase in mortality and appear to reflect the presence of associated collagen vascular disease and high right atrial pressure.

UR - http://www.scopus.com/inward/record.url?scp=84887449986&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84887449986&partnerID=8YFLogxK

U2 - 10.1378/chest.12-3033

DO - 10.1378/chest.12-3033

M3 - Article

C2 - 23949692

AN - SCOPUS:84887449986

VL - 144

SP - 1530

EP - 1538

JO - Chest

JF - Chest

SN - 0012-3692

IS - 5

ER -