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Original article
DOI: 10.1016/j.rccl.2019.12.002
Available online 4 February 2020
Prognostic impact of pericardial drainage and anti-inflammatory drug treatment in severe idiopathic pericardial effusion
Impacto pronóstico del drenaje pericárdico y del tratamiento antiinflamatorio en el derrame pericárdico grave idiopático
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Alejandro Cruz-Utrillaa, Carlos Ferreraa,
Corresponding author
carlosferreraduran@gmail.com

Corresponding author.
, Marcos Ferrández-Escarabajala, Cristina Sánchez-Enriqueb, Iván Núñez-Gila, Francisco J. Noriegaa, Pablo Salinasa, Leopoldo Pérez de Islaa, Carlos Macayaa, Antonio Fernández-Ortiza, Ana Viana-Tejedora
a Departamento de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
b Departamento de Cardiología, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
Received 04 August 2019. Accepted 12 December 2019
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Tables (3)
Table 1. Baseline characteristics of 153 patients with severe pericardial effusion of idiopathic origin.
Table 2. Univariate and multivariate analysis to predict 2-year mortality.
Table 3. Baseline characteristics of 153 patients with severe pericardial effusion of idiopathic origin. Differences between patients who received/did not received anti-inflammatory drugs.
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Additional material (1)
Abstract
Introduction and objectives

Severe pericardial effusion (PE) is a potentially severe clinical entity. Idiopathic PE accounts for one-third of patients with severe PE. However, evidence-based treatments are scarce. The aim of the study was to investigate whether pericardial drainage is associated with prognostic improvement, and to evaluate the influence of anti-inflammatory treatment on prognosis.

Methods

All severe PE diagnosed between 2003 and 2017 were retrospectively collected. Of them, those classified as idiopathic were selected (N=153). Patients were divided in 2 groups: those who underwent pericardial drainage (N=105) and patients who did not (N=48). In addition, the study population was divided according to the anti-inflammatory drug (AD) administration. Median follow-up was 47.7 months.

Results

There were no significant differences in 2-year mortality between patients who underwent pericardial drainage and those who did not. There were also no significant differences in the number of hospitalizations for heart failure between the 2 study groups. However, mortality was significantly lower among patients who received AD compared to those who did not receive these agents. Only treatment with AD (HR, 0.24; P=.002) remained independently associated with lower mortality in the multivariate analysis. AD treatment was associated with a 70% reduction in mortality (HR, 0.30; 95%CI, 0.10–0.90; P<.031).

Conclusions

Pericardial drainage was not associated with a better prognosis of patients with severe idiopathic PE, in terms of 2-year mortality, heart failure admissions, or the combined endpoint. AD treatment was found to be an independent protective factor for mortality in this patient population.

Keywords:
Pericardium
Effusion
Drainage
Inflammation
Treatment
Resumen
Introducción y objetivos

El derrame pericárdico (DP) grave es una entidad potencialmente grave. Hasta un tercio de los casos son catalogados de origen idiopático. Sin embargo, la evidencia acerca del tratamiento es escasa. El propósito de este estudio fue investigar si el drenaje pericárdico se asocia a una mejoría en la supervivencia global, y evaluar la influencia del tratamiento antiinflamatorio (TA) en el pronóstico.

Métodos

Se recogieron retrospectivamente todos los casos de DP grave diagnosticados entre 2003 y 2017. De ellos, se seleccionaron los clasificados como idiopáticos (n=153). Los pacientes se dividieron en 2 grupos: aquellos que se drenaron (n=105) y los que no (n=48). Además, se subdividió a la población dependiendo del uso del TA. La mediana de seguimiento fue de 47,7 meses.

Resultados

No existieron diferencias significativas en la mortalidad a 2 años entre los pacientes que recibieron drenaje pericárdico y los que no. Tampoco hubo diferencias entre el número de hospitalizaciones por insuficiencia cardiaca. Sin embargo, la mortalidad fue significativamente menor entre los que recibieron TA, en comparación con los que no. Solo el TA se mantuvo como un factor protector (HR: 0,24; p=0,002) en el análisis multivariado. El TA se asoció con una reducción de la mortalidad del 70% a 2 años (HR: 0,30; IC 95%; 0,10-0,90; p<0,031).

Conclusiones

El drenaje pericárdico no se asoció con una mejoría en el pronóstico en pacientes con DP grave de origen idiopático a 2 años, ni con una disminución en el número de ingresos por insuficiencia cardiaca o el objetivo combinado de ambos. El TA se mostró como un factor protector en esta población.

Palabras clave:
Pericardio
Derrame
Drenaje
Inflamación
Tratamiento

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