Correlación clínica-ecocardiográfica-hemodinámica en los pacientes con derrame pericárdico severo sometidos a pericardiocentesis.

Abstract

Introduction:_x000D_ Cardiac tamponade syndrome is caused by compression of the heart by pericardial effusion. Prior to the introduction of echocardiography only recognized the blockages that had a clear clinical impact and, therefore, were the most severe. Also, pericardiocentesis with intrapericardial pressure monitoring and intracavitary has identified some severe degrees of tamponade not recognized clinically. Despite the widespread diffusion of these techniques there is little information in the literature on the correlation between the findings provided by the physical examination, echocardiography and hemodynamic study in patients with pericardial effusion._x000D_ Moreover, the analysis of these data allows to extend the concept of tamponade not an all or nothing situation but as a box that responds to a "continuum" of clinical severity._x000D_ Objective:_x000D_ To establish the correlation between the clinical, echocardiographic and hemodynamic study in patients with severe pericardial effusion underwent pericardiocentesis and cardiac catheterization._x000D_ Method:_x000D_ Retrospective observational study on 191 pericardiocentesis procedures combined with cardiac catheterization performed in 168 patients with pericardial effusion between 1990 and 2010 at the Hospital Universitari Vall d'Hebron to establish the relationship between the clinical, echocardiographic data and severity of cardiac tamponade hemodynamic criteria established by._x000D_ Clinical tamponade was defined when there was paradoxical pulse, jugular venous distention or hypotension; Doppler echocardiographic tamponade when there was at least one heart chamber collapse or pathologic variations flow Doppler, and hemodynamic tamponade if right transmural pressure was ≤ 2mmHg or paradoxical pulse more increase in cardiac index> 10% after pericardiocentesis._x000D_ Results:_x000D_ 132 (69.1%) patients had clinical tamponade criteria, 137 (71.7%) Doppler echocardiographic tamponade and 150 (78.5%) had tamponade hemodynamic criteria. The median age was 63.5 years (P25-75: 49.5-71.5). 103 patients were female (53.9%). The most common causes of pericardial effusion were: idiopathic chronic pericardial effusion (52 patients-25, 2%), neoplastic pericardial effusion (49 patients-23, 8%) and due to idiopathic or viral acute pericarditis (38 patients-18, 4%)._x000D_ Correlations:_x000D_ Patients with clinical tamponade: Doppler echocardiographic tamponade: 85.6%, hemodynamic tamponade: 81.8%. Patients without clinical tamponade: absence of Doppler echocardiographic tamponade: 33.9%, no hemodynamic tamponade: 27.1%._x000D_ Patients with Doppler echocardiographic tamponade: clinical tamponade: 73.7%, hemodynamic tamponade: 82.5%. Patients without Doppler echocardiographic tamponade: absence of clinical tamponade: 55.6%, no hemodynamic tamponade: 37%._x000D_ Patients with hemodynamic tamponade: clinical tamponade: 68%, Doppler echocardiographic tamponade: 84.7%. Patients without hemodynamic tamponade: absence of clinical tamponade: 41.5%, no Doppler echocardiographic tamponade: 34.1%._x000D_ Conclusions:_x000D_ The hemodynamic and Doppler echocardiography detect subclinical degrees of tamponade._x000D_ In patients without clinical tamponade criteria, 66.1% had echocardiographic signs and 72.9% had hemodynamic criteria of tamponade._x000D_ 18.2% of patients diagnosed with clinical tamponade and 17.5% of patients with signs of tamponade on echocardiography-Doppler hemodynamic data were not plugging._x000D_ Discrepancies can be explained by the low sensitivity and low specificity of clinical criteria (especially jugular venous distension and hypotension), by the limitations of imaging techniques, by an unusual pathophysiology of tamponade as compression the superior vena cava, or, rather, by the limitations of hemodynamic recording.

Date of Award	16 Dec 2011
Original language	Spanish
Supervisor	Jaume Sagristà Sauleda (Director)