Role of a 12‐Lead Electrocardiogram in the Diagnosis of Cardiac Tamponade as Diagnosed by Transthoracic Echocardiography in Patients With Malignant Pericardial Effusion

Abstract

Background: Few studies have looked at the utility of the 12-lead electrocardiogram (ECG) in diagnosing cardiac tamponade in malignant pericardial effusion (PE). The aim of this study was to determine the sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of 12-lead ECG in diagnosing cardiac tamponade in PE. Hypothesis: Abnormalities on a 12 lead ECG can be used to diagnose or exclude cardiac tamponade in patients with malignant PE. Methods: Using echocardiography as the gold standard for diagnosis of cardiac tamponade, we determined the Se, Sp, PPV, and NPV for individual and combinations of the 3 ECG abnormalities (low-voltage complexes, electrical alternans, and sinus tachycardia). Results: For PEs of all sizes, the Se, Sp, PPV, and NPV for detecting cardiac tamponade were: low-voltage complexes (56%, 74%, 81%, 46%), electrical alternans (23%, 98%, 95%, 39%), and sinus tachycardia (76%, 60%, 79%, 56%), respectively. Presence of all 3 and any of the 3 ECG abnormalities had a Se, Sp, PPV, and NPV of 8%, 100%, 100%, 36% and 89%, 47%, 77%, 69%, respectively, for cardiac tamponade. The odds ratios for cardiac tamponade in PE were 3.7 (95% confidence interval [CI]: 1.65-8.30) for low-voltage complexes, 12.3 (95% CI: 1.58-95.17) for electrical alternans, and 4.9 (95% CI: 2.22-10.80) for sinus tachycardia. Presence of any of 3 ECG abnormalities had an odds ratio of 7.3 (95% CI: 2.9-18

Total electrical alternans in a patient with malignant pericardial tamponade

“…Regarding our case, electrical alternans has been shown to be more prevalent in patients with large effusions of relatively viscous fluid such as malignant pericardial effusion 10. Furthermore, the occurrence of cardiac tamponade, in contrast to the general population is relatively common in patients with malignant pericardial effusion, has a poor prognosis and a patient remain at risk for recurrence of tamponade following pericardiocentesis 11.…”

Electrical swimming

“…These include diffuse PR-segment depression, ST-segment elevation, sinus tachycardia, low QRS voltage and electrical alternans. Though electrical alternans is not consistently present in cardiac tamponade, it is very specific for this condition (specificity 98% and positive predictive value 95%) 1. The simultaneous presence of sinus tachycardia, low QRS voltage and electrical alternans is quite rare (8.3% of patients with pericardial effusion) but their combination has a high sensitivity (100%) and positive predictive value (100%) in the diagnosis of cardiac tamponade 1…”

Response to Role of a 12‐Lead Electrocardiogram in the Diagnosis of Cardiac Tamponade as Diagnosed by Transthoracic Echocardiography in Patients With Malignant Pericardial Effusion

“…1 The authors have commendably reviewed the role of 12-lead electrocardiography in the diagnosis of cardiac tamponade resulting from malignant pericardial effusions.…”