Causes and prognosis of symptomatic pericardial effusions treated by pericardiocentesis in an Asian academic medical centre.

Abstract

INTRODUCTION\nThis study aimed to investigate the causes, clinical management and outcomes of clinically significant pericardial effusions, and evaluate the practice of pericardiocentesis within an academic medical centre in Singapore, a multiethnic country in Southeast Asia.\n\n\nMETHODS\nConsecutive patients undergoing pericardiocentesis at a single Asian academic medical centre were identified. Patient demographics, echocardiographic findings, investigations, pericardiocentesis procedural details and clinical progress were tracked using a comprehensive electronic medical records system.\n\n\nRESULTS\nOf 149 patients who underwent pericardiocentesis, malignancy (46.3%) followed by iatrogenic postsurgical complications (17.6%) were the most common causes of pericardial effusions. 77.3% of effusions were large and 69.8% demonstrated tamponade physiology. Pericardiocentesis guided by echocardiography and fluoroscopy was successful in 98.7% of patients and had a complication rate of 2.1%. Likelihood of effusion recurrence and survival-to-discharge was determined by the aetiology of the pericardial effusion. 24.6% of malignant effusions recurred and survival rates 12 months after drainage of a malignant pericardial effusion was 45.0%. Short-term mortality was highest among patients presenting with tamponade due to acute aortic syndromes and myocardial rupture due to ischaemic heart disease.\n\n\nCONCLUSION\nCancer and iatrogenic complications were the most common causes of pericardial effusion in this large cohort of Singapore patients. Pericardiocentesis has a high success rate and relatively low complication rate. Prognosis and clinical course after pericardiocentesis is determined by the underlying cause of pericardial effusion.