Unveiling the causes of pericardial effusion in a contemporary case series of pericardiocentesis in Latin America

Abstract

Pericardial effusions requiring pericardiocentesis have multiple causes that vary among geographical regions and health contexts. This procedure can be performed for diagnostic or therapeutic indications. The purpose of this study was to identify the principal causes of pericardial effusions and indications for pericardiocentesis, exploring differences among groups. This was a retrospective case series of patients who underwent pericardiocentesis for pericardial effusion in a single center in Latin America. Demographic, clinical, echocardiographic, and procedural variables were recorded and analyzed. The primary outcome was to determine the causes of pericardial effusions in these patients and the indication (diagnostic, therapeutic, or both). The results are presented in two groups (inflammatory and noninflammatory) according to the cause of the pericardial effusion. One hundred sixteen patients with pericardial effusion underwent pericardiocentesis. The median age was 58 years (IQR 46.2–70.7), and 50% were male. In the noninflammatory pericardial effusion group, there were 61 cases (53%), among which neoplastic pericardial effusion was the most frequent cause (n = 25, 40.9%). In the inflammatory group, there were 55 cases (47%), and the main cause was postpericardiectomy syndrome after cardiac surgery (n = 31, 56.4%). In conclusion, the principal indication for pericardiocentesis was therapeutic (n = 66, 56.8%). Large pericardial effusion without hemodynamic effect of cardiac tamponade was significantly more frequent in the inflammatory group (p = 0.03). The principal cause of pericardial effusion in patients who underwent pericardiocentesis was postpericardiectomy syndrome after cardiac surgery, followed by neoplastic pericardial effusion. Pericardiocentesis is mainly a therapeutic procedure.

Clinical characteristics and risk factors of in-hospital mortality among patients undergoing percutaneous pericardiocentesis

“…A discrepancy between indications for pericardiocentesis may be related with the profile of the analyzed center. In the study by Del Portillo-Navarrete JH et al, 26.7% of all patients underwent pericardiocentesis on account of post-pericardiotomy syndrome (10), whereas in our report this indication was responsible for roughly 5% of patients.…”

Pericardial Diseases Mortality Trends in Brazil From 2000 to 2022

“…Due to its often mild and self-resolving nature, mild cases of pericarditis may go undiagnosed, particularly in underdeveloped regions, leading to challenges in determining accurate incidence rates. However, untreated pericarditis can exacerbate and prolong recovery [9]. A Danish study comparing pericarditis patients to a matched-control group found a five-year survival rate of 92.9% in the pericarditis cohort, slightly lower than the 95.8% observed in the control group.…”

“…A recent study conducted in Latin America, involving 106 patients with significant pericardial effusions, revealed that less than 10% of cases were of idiopathic origin, while infections accounted for less than 8% of cases, with TB being relatively rare [9]. In Brazil, idiopathic causes were identified as the primary culprit for pericardial effusion without tamponade, whereas post-surgical complications were the leading cause among inpatients with pericardial effusion accompanied by cardiac tamponade.…”