Intrahospital mortality of patients presenting with cardiac tamponade: retrospective analysis

    Authors

    Abstract

    **Introduction**: The pericardium is a double-walled sac (consisting of visceral and fibrous layers) between which lies the pericardial space, enveloping the heart and the roots of blood vessels entering or exiting the heart (1). Although pericardial effusion can arise from various pathological conditions, its etiology is typically presumed based on clinical presentation and comorbidities, and an accurate diagnosis is established through biochemical, microbiological, and cytological analysis of the effusion. However, pericardiocentesis is an invasive procedure indicated when effusion onset is symptomatic or accompanied by tamponade, or when its etiology is unclear (2, 3). **Patients and Methods**: The retrospective analysis included 48 patients with echocardiographically confirmed cardiac tamponade of various etiologies in the period from 2016 to 2021. Descriptive statistical data are presented as a percentage. Due to a small sample size and uneven distribution, the examination of intrahospital mortality between patient groups, based on etiology and effusion treatment, was performed using the Fisher’s exact test and statistical significance was indicated as p-value 0.05). However, patients treated with a combination of cisplatin and pericardiocentesis had a lower mortality rate compared to those treated with pericardiocentesis alone, p < 0.05 (**Figure 1**). ### TABLE 1: The patient characteristics. | | **No. of patients (%)** | | --- | --- | | **Sex** | | | Males | 32 (66.7) | | Females | 16 (33.3) | | **Etiology** | | | Malignant disease | 19 (39.6) | | Inflammation | 8 (16.7) | | Post-procedural | 7 (14.6) | | Other | 14 (29.2) | | **Therapy** | | | No therapy | 1 (2.1) | | Drainage | 36 (75.0) | | Surgery | 8 (16.7) | | Conservative | 3 (6.3) | | **Application of cisplatin** | | | No | 39 (81.3) | | Yes | 9 (18.8) | | **Intrahospital mortality** | | | No | 35 (72.9) | | Yes | 13 (27.1) | | **Total** | 48 (100) | FIGURE 1. Statistically significant difference in intrahospital survival among patients treated with a combination of cisplatin and pericardiocentesis and those undergoing pericardiocentesis alone (p = 0.016 - Fisher’s exact test). **Conclusion**: Malignant diseases are one of the leading causes of death worldwide, and when combined with pericardial effusion and tamponade, the most common ones are lung and breast cancer, melanoma, and lymphoma. The therapy of choice for acutely occurring pericardial effusion is pericardiocentesis, which alleviates symptoms and provides additional diagnostic possibilities. The effectiveness of cisplatin administration in combination with pericardiocentesis is independent of hemodynamic instability parameters and inflammatory markers in patients with recurrent pericardial effusion.

    Keywords

    cardiac tamponade, cisplatin, intrahospital mortality, pericardiocentesis

    DOI

    https://doi.org/10.15836/ccar2024.135

    Literature

    1. Little WC, Freeman GL. Pericardial disease. Circulation. 2006 March 28;113(12):1622–32. https://doi.org/10.1161/CIRCULATIONAHA.105.561514
    2. Sagristà-Sauleda J, Mercé AS, Soler-Soler J. Diagnosis and management of pericardial effusion. World J Cardiol. 2011 May 26;3(5):135–43. https://doi.org/10.4330/wjc.v3.i5.135
    3. Darocha S, Wilk M, Walaszkowska-Czyż A, Kępski J, Mańczak R, Kurzyna M, et al. Determinants of Survival After Emergency Intrapericardial Cisplatin Treatment in Cancer Patients with Recurrent Hemodynamic Instability After Pericardiocentesis. In Vivo. 2018 March-April;32(2):373–9. https://doi.org/10.21873/invivo.11248
    Cardiologia Croatica
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    Intrahospital mortality of patients presenting with cardiac tamponade: retrospective analysis

    Extended Abstract
    Issue3-4
    Published
    Pages135-136
    PDF via DOIhttps://doi.org/10.15836/ccar2024.135
    cardiac tamponade
    cisplatin
    intrahospital mortality
    pericardiocentesis

    Authors

    Domagoj Vučić*ORCIDGeneral Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
    Sergej NadalinORCIDGeneral Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
    Zvonimir BosnićORCIDJosip Juraj Strossmayer University of Osijek, Osijek, Croatia
    Ana KovačevićORCIDGeneral Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
    Katica Cvitkušić LukendaORCIDGeneral Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia

    *Correspondence email: domagojvucicmedri@gmail.com

    Abstract

    **Introduction**: The pericardium is a double-walled sac (consisting of visceral and fibrous layers) between which lies the pericardial space, enveloping the heart and the roots of blood vessels entering or exiting the heart (1). Although pericardial effusion can arise from various pathological conditions, its etiology is typically presumed based on clinical presentation and comorbidities, and an accurate diagnosis is established through biochemical, microbiological, and cytological analysis of the effusion. However, pericardiocentesis is an invasive procedure indicated when effusion onset is symptomatic or accompanied by tamponade, or when its etiology is unclear (2, 3). **Patients and Methods**: The retrospective analysis included 48 patients with echocardiographically confirmed cardiac tamponade of various etiologies in the period from 2016 to 2021. Descriptive statistical data are presented as a percentage. Due to a small sample size and uneven distribution, the examination of intrahospital mortality between patient groups, based on etiology and effusion treatment, was performed using the Fisher’s exact test and statistical significance was indicated as p-value 0.05). However, patients treated with a combination of cisplatin and pericardiocentesis had a lower mortality rate compared to those treated with pericardiocentesis alone, p < 0.05 (**Figure 1**). ### TABLE 1: The patient characteristics. | | **No. of patients (%)** | | --- | --- | | **Sex** | | | Males | 32 (66.7) | | Females | 16 (33.3) | | **Etiology** | | | Malignant disease | 19 (39.6) | | Inflammation | 8 (16.7) | | Post-procedural | 7 (14.6) | | Other | 14 (29.2) | | **Therapy** | | | No therapy | 1 (2.1) | | Drainage | 36 (75.0) | | Surgery | 8 (16.7) | | Conservative | 3 (6.3) | | **Application of cisplatin** | | | No | 39 (81.3) | | Yes | 9 (18.8) | | **Intrahospital mortality** | | | No | 35 (72.9) | | Yes | 13 (27.1) | | **Total** | 48 (100) | FIGURE 1. Statistically significant difference in intrahospital survival among patients treated with a combination of cisplatin and pericardiocentesis and those undergoing pericardiocentesis alone (p = 0.016 - Fisher’s exact test). **Conclusion**: Malignant diseases are one of the leading causes of death worldwide, and when combined with pericardial effusion and tamponade, the most common ones are lung and breast cancer, melanoma, and lymphoma. The therapy of choice for acutely occurring pericardial effusion is pericardiocentesis, which alleviates symptoms and provides additional diagnostic possibilities. The effectiveness of cisplatin administration in combination with pericardiocentesis is independent of hemodynamic instability parameters and inflammatory markers in patients with recurrent pericardial effusion.

    Literature

    1. 1.
      Little WC, Freeman GL. Pericardial disease. Circulation. 2006 March 28;113(12):1622–32.DOI
    2. 2.
      Sagristà-Sauleda J, Mercé AS, Soler-Soler J. Diagnosis and management of pericardial effusion. World J Cardiol. 2011 May 26;3(5):135–43.DOI
    3. 3.
      Darocha S, Wilk M, Walaszkowska-Czyż A, Kępski J, Mańczak R, Kurzyna M, et al. Determinants of Survival After Emergency Intrapericardial Cisplatin Treatment in Cancer Patients with Recurrent Hemodynamic Instability After Pericardiocentesis. In Vivo. 2018 March-April;32(2):373–9.DOI