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

  • Hilmi Alnsasra
    MedStar Heart and Vascular Institute MedStar Washington Hospital Center Washington DC USA
  • Brian C. Case
    Section of Interventional Cardiology MedStar Washington Hospital Center Washington DC USA
  • Michael Yang
    Department of Medicine MedStar Georgetown University Hospital Washington DC USA
  • Toby Rogers
    MedStar Heart and Vascular Institute MedStar Washington Hospital Center Washington DC USA
  • Lowell F. Satler
    Section of Interventional Cardiology MedStar Washington Hospital Center Washington DC USA
  • Federico M. Asch
    MedStar Health Research Institute MedStar Washington Hospital Center Washington DC USA
  • Ron Waksman
    MedStar Heart and Vascular Institute MedStar Washington Hospital Center Washington DC USA
  • Preetham Kumar
    MedStar Heart and Vascular Institute MedStar Washington Hospital Center Washington DC USA
  • Itsik Ben‐Dor
    Section of Interventional Cardiology MedStar Washington Hospital Center Washington DC USA
  • Diego Medvedofsky
    MedStar Heart and Vascular Institute MedStar Washington Hospital Center Washington DC USA

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<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>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).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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 cm<jats:sup>2</jats:sup>–26.4 ± 8.4 cm<jats:sup>2</jats:sup>, <jats:italic>P</jats:italic> = .01) and (15.9 ± 6.3 cm<jats:sup>2</jats:sup>–18.7 ± 6.5 cm<jats:sup>2</jats:sup>, <jats:italic>P</jats:italic> = .02), respectively. However, RV function indices including fractional area change (FAC: 30.6 ± 13.7%–29.1 ± 8.8%, <jats:italic>P</jats:italic> = .61) and free‐wall longitudinal strain (FWLS: −16.7 ± 6.7 to −15.9 ± 5.0, <jats:italic>P</jats:italic> = .50) remained unchanged postpericardiocentesis. In contrast, in the non‐PH group, after pericardiocentesis, EDA increased significantly (20.4 ± 6.2–22.4 ± 5.9 cm<jats:sup>2</jats:sup>, <jats:italic>P</jats:italic> = .006) but ESA did not (14.9 ± 5.7 vs 15.0 ± 4.6 cm<jats:sup>2</jats:sup>, <jats:italic>P</jats:italic> = .89), and RV function indices improved (FAC 27.9 ± 11.7%–33.1 ± 8.5%, <jats:italic>P</jats:italic> = .003; FWLS −13.6 ± 5.4 to −17.2 ± 3.9%, <jats:italic>P</jats:italic> < .001).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>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.</jats:p></jats:sec>

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