Pericardiocentesis induced right ventricular changes in patients with and without pulmonary hypertension.

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Citation: Echocardiography. 2021 Apr 09PMID: 33835611Institution: MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: Cardiovascular Disease Fellowship | Interventional Cardiology FellowshipForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2021ISSN:
  • 0742-2822
Name of journal: Echocardiography (Mount Kisco, N.Y.)Abstract: BACKGROUND: Pericardial effusion drainage in patients with significant pulmonary hypertension (PH) has been questioned because of hemodynamic collapse concern, mainly because of right ventricular (RV) function challenging assessment. We aimed to assess RV function changes related to pericardiocentesis in patients with and without PH.CONCLUSION: Quantification of RV size and function can improve understanding of echocardiographic and hemodynamic changes postpericardiocentesis, which has the potential to guide management of PH patients with large pericardial effusion. Copyright (c) 2021 Wiley Periodicals LLC.METHODS: Consecutive patients with symptomatic moderate-to-large pericardial effusion who had either echocardiographic or clinical signs of cardiac tamponade and who underwent pericardiocentesis from 2013 to 2018 were included. RV speckle-tracking echocardiography analysis was performed before and after pericardiocentesis. Patients were stratified by significant PH (pulmonary artery systolic pressure [PASP] >=50 mm Hg).RESULTS: The study cohort consisted of 76 patients, 23 (30%) with PH. In patients with PH, both end-diastolic and end-systolic areas (EDA, ESA) increased significantly after pericardiocentesis (22.6 +/- 8.0 cm2 -26.4 +/- 8.4 cm2 , P = .01) and (15.9 +/- 6.3 cm2 -18.7 +/- 6.5 cm2 , P = .02), respectively. However, RV function indices including fractional area change (FAC: 30.6 +/- 13.7%-29.1 +/- 8.8%, P = .61) and free-wall longitudinal strain (FWLS: -16.7 +/- 6.7 to -15.9 +/- 5.0, P = .50) remained unchanged postpericardiocentesis. In contrast, in the non-PH group, after pericardiocentesis, EDA increased significantly (20.4 +/- 6.2-22.4 +/- 5.9 cm2 , P = .006) but ESA did not (14.9 +/- 5.7 vs 15.0 +/- 4.6 cm2 , P = .89), and RV function indices improved (FAC 27.9 +/- 11.7%-33.1 +/- 8.5%, P = .003; FWLS -13.6 +/- 5.4 to -17.2 +/- 3.9%, P < .001).All authors: Alnsasra H, Asch FM, Ben-Dor I, Case BC, Kumar P, Medvedofsky D, Rogers T, Satler LF, Waksman R, Yang MFiscal year: FY2021Digital Object Identifier: ORCID: Date added to catalog: 2021-06-07
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Journal Article MedStar Authors Catalog Article 33835611 Available 33835611

BACKGROUND: Pericardial effusion drainage in patients with significant pulmonary hypertension (PH) has been questioned because of hemodynamic collapse concern, mainly because of right ventricular (RV) function challenging assessment. We aimed to assess RV function changes related to pericardiocentesis in patients with and without PH.

CONCLUSION: Quantification of RV size and function can improve understanding of echocardiographic and hemodynamic changes postpericardiocentesis, which has the potential to guide management of PH patients with large pericardial effusion. Copyright (c) 2021 Wiley Periodicals LLC.

METHODS: Consecutive patients with symptomatic moderate-to-large pericardial effusion who had either echocardiographic or clinical signs of cardiac tamponade and who underwent pericardiocentesis from 2013 to 2018 were included. RV speckle-tracking echocardiography analysis was performed before and after pericardiocentesis. Patients were stratified by significant PH (pulmonary artery systolic pressure [PASP] >=50 mm Hg).

RESULTS: The study cohort consisted of 76 patients, 23 (30%) with PH. In patients with PH, both end-diastolic and end-systolic areas (EDA, ESA) increased significantly after pericardiocentesis (22.6 +/- 8.0 cm2 -26.4 +/- 8.4 cm2 , P = .01) and (15.9 +/- 6.3 cm2 -18.7 +/- 6.5 cm2 , P = .02), respectively. However, RV function indices including fractional area change (FAC: 30.6 +/- 13.7%-29.1 +/- 8.8%, P = .61) and free-wall longitudinal strain (FWLS: -16.7 +/- 6.7 to -15.9 +/- 5.0, P = .50) remained unchanged postpericardiocentesis. In contrast, in the non-PH group, after pericardiocentesis, EDA increased significantly (20.4 +/- 6.2-22.4 +/- 5.9 cm2 , P = .006) but ESA did not (14.9 +/- 5.7 vs 15.0 +/- 4.6 cm2 , P = .89), and RV function indices improved (FAC 27.9 +/- 11.7%-33.1 +/- 8.5%, P = .003; FWLS -13.6 +/- 5.4 to -17.2 +/- 3.9%, P < .001).

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