Key result
Inflammatory conditions linked to PR-segment depression in up to ~46% of asymptomatic pericardial effusion patients.
Why the study?
Pericardial effusion is relatively common, but few studies have evaluated ECG changes associated with its occurrence.
What are the clinical correlates of PR-segment depression in asymptomatic patients with pericardial effusion?
Cross-Sectional (n=176)
What are the clinical correlates of PR-segment depression in asymptomatic patients with pericardial effusion?
PR-segment depression is a relatively common ECG finding (23%) in asymptomatic patients with pericardial effusion and serves as a useful indicator of inflammatory pericardial involvement.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Asymptomatic pericardial effusion can also be associated with PR segment depression according to Kudo Y et al. PR segment depression was noted in 40 of their 176 asymptomatic patients referred for echocardiography. ST elevation was noted in 8 of these patients (PR-ST dissociation).”
PR depression may flag inflammation in asymptomatic effusion but should not change practice; leaves open prospective validation in malignancy or CTD.
OBJECTIVES The purpose of this study was to determine the clinical correlates of PR-segment depression among consecutive asymptomatic patients with pericardial effusion (PE) detected by routine echocardiography. BACKGROUND Pericardial effusion is a relatively common finding in clinical practice, but not many studies have evaluated electrocardiographic (ECG) changes associated with the occurrence of PE. METHODS Among 4,061 consecutive patients referred to our echocardiography laboratory, 176 asymptomatic patients had PE correlated with their clinical history and ECG findings. RESULTS PR-segment depression was detected in 40 patients (23%). There were no significant differences in age, gender distribution or heart rate between patients with and without PR-segment depression. Fifteen post-pericardiotomy patients (33%), 19 patients (40%) with malignant disease and 6 patients (46%) with connective tissue disease had PR-segment depression, whereas no patient with heart disease (dilated cardiomyopathy, hypertensive heart disease, old myocardial infarction, valvular heart disease), renal disease or hypothyroidism had PR-segment depression, nor widespread ST-segment elevation. Among 40 patients with PR-segment depression, 8 had ST-segment elevation in the leads of epicardial derivation, 8 had upright T waves, 20 had low to inverted T waves with an isoelectric ST-segment and 4 had ST-T-wave changes due to bundle branch block. CONCLUSIONS PR-segment depression was a relatively common ECG sign associated with clinically silent PE, and it was an ECG indicator of inflammatory pericardial involvement.
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Kudo et al. (2002) conducted a cross-sectional in Asymptomatic pericardial effusion (n=176). Inflammatory conditions (connective tissue disease, malignancy, post-pericardiotomy) vs. Non-inflammatory conditions (heart disease, renal disease, hypothyroidism) was evaluated on PR-segment depression. Inflammatory conditions (connective tissue disease, malignancy, post-pericardiotomy) were associated with PR-segment depression in 46%, 40%, and 33% of asymptomatic pericardial effusion patients.
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