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Differential Impact of Constrictive Physiology after Pericardiocentesis in Malignancy Patients with Pericardial Effusion

 In-Jeong Cho  ;  Hyuk-Jae Chang  ;  Hyemoon Chung  ;  Sang-Eun Lee  ;  Chi Young Shim  ;  Geu-Ru Hong  ;  Jong-Won Ha  ;  Namsik Chung 
 PLoS One, Vol.10(12) : e0145461, 2015 
Journal Title
 PLoS One 
Issue Date
Aged ; Echocardiography* ; Female ; Heart/physiopathology* ; Humans ; Male ; Middle Aged ; Neoplasms/complications* ; Neoplasms/mortality ; Neoplasms/pathology ; Pericardial Effusion/diagnosis ; Pericardial Effusion/etiology ; Pericardial Effusion/mortality ; Pericardial Effusion/surgery* ; Pericardiocentesis/adverse effects* ; Pericardiocentesis/methods ; Retrospective Studies
BACKGROUND: Echocardiographic signs of constrictive physiology (CP) after pericardiocentesis are frequently observed in malignancy patients. The purpose of the current study was to explore whether features of CP after pericardiocentesis have prognostic impact in malignancy patients with pericardial effusion (PE). METHODS: We retrospectively reviewed 467 consecutive patients who underwent pericardiocentesis at our institution from January 2006 to May 2014. Among them, 205 patients with advanced malignancy who underwent comprehensive echocardiography after the procedure comprised the study population. Co-primary end points were all-cause mortality (ACM) and repeated drainage (RD) for PE. Patients were divided into four subgroups according to cytologic result for malignant cells and CP (positive cytology with negative CP, both positive, both negative, and negative cytology with positive CP). RESULTS: CP after pericardiocentesis was present in 106 patients (50%) at median 4 days after the procedure. During median follow-up of 208 days, ACM and RD occurred in 162 patients (79%) and 29 patients (14%), respectively. Cox regression analysis revealed that independent predictors for ACM were male gender and positive cytology (all, p < 0.05). For RD, predictors were positive cytology, the absence of cardiac tamponade, and negative CP after pericardiocentesis (all, p < 0.05). When the patients were divided into four subgroups, patients with negative cytology and positive CP demonstrated the most favorable survival (hazard ratio [HR]: 0.39, p = 0.005) and the lowest RD rates (HR: 0.07, p = 0.012). CONCLUSION: CP after pericardiocentesis is common, but does not always imply poor survival or the need for RD in patients with advanced malignancies. On the contrary, the presence of CP in patients with negative cytology conferred the most favorable survival and the lowest rate of RD. Comprehensive echocardiographic evaluation for CP after pericardiocentesis would be helpful for predicting prognosis in patients with advanced malignancies.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
심지영(Shim, Chi Young) ORCID logo https://orcid.org/0000-0002-6136-0136
이상은(Lee, Sang Eun) ORCID logo https://orcid.org/0000-0001-6645-4038
장혁재(Chang, Hyuck Jae) ORCID logo https://orcid.org/0000-0002-6139-7545
정남식(Chung, Nam Sik)
정혜문(Chung, Hye Moon)
조인정(Cho, In Jeong)
하종원(Ha, Jong Won) ORCID logo https://orcid.org/0000-0002-8260-2958
홍그루(Hong, Geu Ru) ORCID logo https://orcid.org/0000-0003-4981-3304
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