Key result
In patients with advanced malignancies undergoing pericardiocentesis, the presence of constrictive physiology with negative cytology was associated with the most favorable survival (HR 0.39).
Why the study?
Does the presence of constrictive physiology after pericardiocentesis predict all-cause mortality and repeated drainage in patients with advanced malignancies and pericardial effusion?
Cohort (n=205)
No
Does the presence of constrictive physiology after pericardiocentesis predict all-cause mortality and repeated drainage in patients with advanced malignancies and pericardial effusion?
The presence of echocardiographic constrictive physiology after pericardiocentesis in malignancy patients with negative cytology is associated with favorable survival and a lower rate of repeated drainage.
Answers are grounded in this paper and cite their sources.
May aid post-pericardiocentesis prognostication in malignancy; hypothesis-generating and requires prospective validation before guiding practice.
BACKGROUND: Echocardiographic signs of constrictive physiology (CP) after pericardiocentesis are frequently observed in malignancy patients. The purpose of the current study was to explore whether features of CP after pericardiocentesis have prognostic impact in malignancy patients with pericardial effusion (PE). METHODS: We retrospectively reviewed 467 consecutive patients who underwent pericardiocentesis at our institution from January 2006 to May 2014. Among them, 205 patients with advanced malignancy who underwent comprehensive echocardiography after the procedure comprised the study population. Co-primary end points were all-cause mortality (ACM) and repeated drainage (RD) for PE. Patients were divided into four subgroups according to cytologic result for malignant cells and CP (positive cytology with negative CP, both positive, both negative, and negative cytology with positive CP). RESULTS: CP after pericardiocentesis was present in 106 patients (50%) at median 4 days after the procedure. During median follow-up of 208 days, ACM and RD occurred in 162 patients (79%) and 29 patients (14%), respectively. Cox regression analysis revealed that independent predictors for ACM were male gender and positive cytology (all, p < 0.05). For RD, predictors were positive cytology, the absence of cardiac tamponade, and negative CP after pericardiocentesis (all, p < 0.05). When the patients were divided into four subgroups, patients with negative cytology and positive CP demonstrated the most favorable survival (hazard ratio [HR]: 0.39, p = 0.005) and the lowest RD rates (HR: 0.07, p = 0.012). CONCLUSION: CP after pericardiocentesis is common, but does not always imply poor survival or the need for RD in patients with advanced malignancies. On the contrary, the presence of CP in patients with negative cytology conferred the most favorable survival and the lowest rate of RD. Comprehensive echocardiographic evaluation for CP after pericardiocentesis would be helpful for predicting prognosis in patients with advanced malignancies.
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Cho et al. (2015) conducted a cohort in Advanced solid malignancies with pericardial effusion (n=205). Constrictive physiology with negative cytology vs. Positive cytology with negative constrictive physiology was evaluated on All-cause mortality (HR 0.39, 95% CI 0.20-0.72, p=0.005). In patients with advanced malignancies undergoing pericardiocentesis, the presence of constrictive physiology with negative cytology was associated with the most favorable survival (HR 0.39).
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