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

Hilmi Alnsasra, Brian C. Case, Michael Yang, Toby Rogers, Lowell F. Satler, Federico M. Asch, Ron Waksman, Preetham Kumar, Itsik Ben-Dor, Diego Medvedofsky

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: 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. Methods: 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). Results: 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 cm2–26.4 ± 8.4 cm2, P =.01) and (15.9 ± 6.3 cm2–18.7 ± 6.5 cm2, P =.02), respectively. However, RV function indices including fractional area change (FAC: 30.6 ± 13.7%–29.1 ± 8.8%, P =.61) and free-wall longitudinal strain (FWLS: −16.7 ± 6.7 to −15.9 ± 5.0, P =.50) remained unchanged postpericardiocentesis. In contrast, in the non-PH group, after pericardiocentesis, EDA increased significantly (20.4 ± 6.2–22.4 ± 5.9 cm2, P =.006) but ESA did not (14.9 ± 5.7 vs 15.0 ± 4.6 cm2, P =.89), and RV function indices improved (FAC 27.9 ± 11.7%–33.1 ± 8.5%, P =.003; FWLS −13.6 ± 5.4 to −17.2 ± 3.9%, P <.001). Conclusion: 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.

Original languageEnglish
Pages (from-to)752-759
Number of pages8
JournalEchocardiography
Volume38
Issue number5
DOIs
StatePublished - 1 May 2021
Externally publishedYes

Keywords

  • cardiac tamponade
  • longitudinal strain
  • pericardial effusion
  • pulmonary hypertension
  • right ventricular systolic function
  • speckle-tracking echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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