Pericardiocentesis vs conservative management in patients with asymptomatic, chronic, large, idiopathic, C-reactive negative pericardial effusion

Background/Introduction Pericardial effusion (PE) prognosis largely depends on the underlying etiology. Purpose We sought to assess the outcome of patients with asymptomatic, chronic (>3 months), large (diastolic echo-free space >2 cm), idiopathic (without apparent etiology), C-reactive protein (CRP) negative PE, undergoing either pericardiocentesis or conservative management. Methods A total of n=61 patients aged 66.8±15.6 years (women n=32, 53%) were enrolled in this study. Patients were treated by pericardiocentesis (n=39) or conservatively (n=22) at the discretion of treating physician and personal preference. The median follow-up was 24 months (interquartile range: 15 to 36). Results Among those patients undergoing pericardiocentesis, PE re-accumulation (any) occurred in 30 cases (76.9%) with large re-accumulation occurring in 41% of patients. Patients with re-accumulation had higher baseline maximum PE diameter (30±1.5mm vs. 25±1.5mm, p=0.02). In patients managed conservatively effusion size remained overall stable in 17 cases (77%), regressed in 3 cases (14%) and increased leading to near or overt tamponade in 2 cases (9,1%). Complicated course occurred in 5 cases (12.8%) of patients undergoing pericardiocentesis [4 cases of cardiac tamponade (10.2%) and 1 recurrent pericarditis] and in 2 conservatively treated patients (cardiac tamponade). Notably, pericardiocentesis was not helpful in establishing new diagnoses and guide treatment. The complications free survival rate was not significantly different between patients undergoing pericardiocentesis and those treated conservatively (long rank chi2=0.504, p=0.478) (Figure 1). Conclusions In conclusion, in asymptomatic patients with chronic, large, hemodynamically irrelevant, CRP negative, idiopathic PE, conservative management seems a more reasonable approach in most cases.