The Role of Vital Signs in Predicting Cardiac Tamponade in Asymptomatic Patients with Malignancy: Associated Pericardial Effusion

Background: Cardiac tamponade is a potentially life-threatening complication in patients with advanced lung cancer or other metastatic malignant diseases. However, few reports described how to assess the risk for developing cardiac tamponade in asymptomatic patients with pericardial effusion. Methods: The medical records of all patients with malignancy-associated cardiac tamponade diagnosed between April 2006 and June 2012 at Kyorin Hospital were retrospectively reviewed. This study mainly focused on the correlation between the duration between the first recognition of pericardial effusion on computed tomography and cardiac tamponade diagnosis and the vital signs at each point. Results: We identified 17 patients with malignancy-associated cardiac tamponade, mainly due to lung cancer (n=11, adenocarcinoma; n=1, non-small cell carcinoma; n=1, large cell neuroendocrine carcinoma; n=1, small cell carcinoma; and n=1, squamous cell carcinoma) followed by malignant mesothelioma (n=1), and an unknown cause (n=1). Among 17 patients with cardiac tamponade, the systolic blood pressure at the time of malignancy diagnosis was significantly higher than that at the onset of cardiac tamponade (averageSD, 11513 vs 9525 mm Hg; p=0.014), whereas heart rate (HR) and cardiothoracic ratio (CTR) determined on chest radiography were significantly higher at the onset of cardiac tamponade (HR, 8415 bpm vs 11130; p<0.001) (CTR, 497% vs 714.9; p=0.001). The correlation coefficient between the days from the first recognition of pericardial effusion on thoracic computed tomography to cardiac tamponade diagnosis and the gap of vital signs at each point such as HR (r=-0.422, p=0.345) and CTR (r=-0.212, p=0.647) was not statistically significant. Conclusion: This preliminary study demonstrated that increased HR and CTR are essential signs for predicting malignancy-associated cardiac tamponade.