Pericardial effusion and in-hospital mortality in adults hospitalized with severe or greater tricuspid regurgitation: A multicenter registry study

Background: Pericardial effusion (PE) reflects advanced right-sided congestion in patients with severe or greater tricuspid regurgitation (TR). Aims: To define the prevalence and phenotype of PE and to examine its association with in-hospital mortality. Methods: This was a retrospective analysis of a prospective, observational multicenter TR registry from 18 cardiology centers in Poland. Consecutive adult patients hospitalized with severe, massive, or torrential TR were included in the study irrespective of TR etiology or admission indication. PE was the main variable of interest, and the main outcome was in-hospital death. Multivariable logistic regression adjusted for age, sex, TR severity, tricuspid annular plane systolic excursion, and chronic kidney disease was performed. Results: Of 1295 registry patients, 1235 (median age 76 [interquartile range 69.0–83.0] years; 53.4% women) had available PE and mortality data and were included in the analysis. PE was observed in 234 patients (19.0%). Patients with PE more often had unplanned admission (58.1% vs. 43.8%; P <0.001), torrential TR (17.5% vs. 8.7%; P <0.001), and pleural effusion (30.8% vs. 16.0%; P <0.001). In-hospital death occurred in 19/234 patients with PE (8.1%) and 37/1001 without PE (3.7%), corresponding to an absolute risk difference of 4.4% (95% confidence interval, 0.7%–8.1%; P = 0.008). In multivariable logistic regression model, PE was associated with higher odds of in-hospital death (odds ratio, 1.98; 95% confidence interval, 1.21–3.22; P = 0.006), consistent across sensitivity analyses. Conclusions: PE is associated with a more advanced congestion phenotype and significantly higher in-hospital mortality in patients with severe or greater TR.