Clinical differences and outcomes in patients with cardiac tamponade of malignant and nonmalignant aetiology

Introduction: Metastatic tumors are the most frequent cause of peri-cardial manifestations, with metastatic tumors being most frequent. Pericardial effusion in malignancy is a marker of poor short-term prognosis. This study evaluated the differences in the clinical presentation, complications, and short-term survival of patients with cardiac tamponade of malignant versus nonmalignant etiology. Methods: We included all patients referred to the University Clinical Center of Serbia for pericardiocentesis from February 2021 to June 2022. Clinical data, physical examination, laboratory analysis, and imaging were collected. Pericardiocentesis was guided by echocardiography or fluoroscopy, depending on availability and clinician assessment. Procedural complications and survival data at 3 months were recorded. Results: The study included 71 patients with cardiac tamponade (52.1% female, mean age 59.7±15.7 years). The major symptom on presentation was dyspnea (63.4%), followed by chest pain (15.4%). The most common comorbidity was malignancy (56.3%), predominantly lung carcinoma (29.5%), followed by breast carcinoma (11.3%) and lymphoproliferative disease (8.5%). Hemorrhagic effusions were the most frequent (62%), especially in malignancy (70%), with a higher average total drainage volume in malignant effusions (1713.5 ml vs. 1503.5 ml). Pericardiocentesis was successful in 97.1% of cases, with minor complications in 14% of patients. The rate of complications did not differ between the two groups, and at the 3-month follow-up, out of all patients with a fatal outcome, 72.7% had malignant disease. Conclusion: Malignant disease is the predominant cause of cardiac tamponade and poor short-term mortality, and pericardiocentesis complications are rare and minor if the procedure is performed in a high-volume tertiary center.