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Haemodynamically irrelevant pericardial effusion is associated with increased mortality in patients with chronic heart failure

Fröhlich, Georg M. ; Keller, Philipp ; Schmid, Florian ; Wolfrum, Mathias ; Osranek, Martin ; Falk, Christian ; Noll, Georg ; Enseleit, Frank ; Reinthaler, Markus ; Meier, Pascal ; Lüscher, Thomas F. ; Ruschitzka, Frank ; Tanner, Felix C.

In: European Heart Journal, 2013, vol. 34, no. 19, p. 1414-1423

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    Titre
    • Haemodynamically irrelevant pericardial effusion is associated with increased mortality in patients with chronic heart failure
    Auteur
    • Fröhlich, Georg M.. Cardiovascular Center, Cardiology, University Hospital Zurich, Rämistrasse 100, Zurich CH-8091, Switzerland
    • Keller, Philipp. Cardiovascular Center, Cardiology, University Hospital Zurich, Rämistrasse 100, Zurich CH-8091, Switzerland
    • Schmid, Florian. Cardiovascular Center, Cardiology, University Hospital Zurich, Rämistrasse 100, Zurich CH-8091, Switzerland
    • Wolfrum, Mathias. Cardiovascular Center, Cardiology, University Hospital Zurich, Rämistrasse 100, Zurich CH-8091, Switzerland
    • Osranek, Martin. Cardiovascular Center, Cardiology, University Hospital Zurich, Rämistrasse 100, Zurich CH-8091, Switzerland
    • Falk, Christian. Cardiovascular Center, Cardiology, University Hospital Zurich, Rämistrasse 100, Zurich CH-8091, Switzerland
    • Noll, Georg. Cardiovascular Center, Cardiology, University Hospital Zurich, Rämistrasse 100, Zurich CH-8091, Switzerland
    • Enseleit, Frank. Cardiovascular Center, Cardiology, University Hospital Zurich, Rämistrasse 100, Zurich CH-8091, Switzerland
    • Reinthaler, Markus. The Heart Hospital, University College London Hospitals, London, UK
    • Meier, Pascal. The Heart Hospital, University College London Hospitals, London, UK
    • Lüscher, Thomas F.. Cardiovascular Center, Cardiology, University Hospital Zurich, Rämistrasse 100, Zurich CH-8091, Switzerland
    • Ruschitzka, Frank. Cardiovascular Center, Cardiology, University Hospital Zurich, Rämistrasse 100, Zurich CH-8091, Switzerland
    • Tanner, Felix C.. Cardiovascular Center, Cardiology, University Hospital Zurich, Rämistrasse 100, Zurich CH-8091, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • European Heart Journal, 2013, vol. 34, no. 19, p. 1414-1423. Oxford University Press
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:291953
    Summary
    Aims Pericardial effusion (PE) is a common finding in cardiac patients with chronic heart failure. The prognostic relevance of a small, haemodynamically non-compromising PE in such patients, however, remains to be determined. Methods and results All patients referred to our heart failure clinic and having a baseline echocardiography and follow-up clinical visits were included. Patients with a haemodynamically relevant PE, acute myo-/pericarditis, systemic sclerosis, rheumatoid arthritis, heart transplantation, heart surgery within the last 6 months or malignancies within the last 3 years were excluded. Patients with or without a haemodynamically irrelevant PE were compared regarding all-cause mortality as the primary and cardiovascular death or need for heart transplantation as secondary outcomes. A total of 897 patients (824 patients in the control vs. 73 patients in the PE group) were included. In the PE group, left ventricular ejection fraction (LVEF) was lower [31%, interquartile range (IQR): 18.0-45.0] than in controls (34%, IQR: 25.0-47.0; P = 0.04), while the end-systolic diameters of the left ventricle and the left atrium were larger (P = 0.01 and P = 0.001, respectively). Similarly, in patients with PE, the right ventricle (RV) systolic function was lower (P < 0.005 for both the fractional area change and the tricuspid annulus movement), the dimensions of RV and right atrium (RA) were larger (P < 0.05 for RV and P < 0.01 for RA), and the degree of tricuspid regurgitation was higher (P < 0.0001). Furthermore, in the PE group, the heart rate was higher (P < 0.001) and the leukocyte count as well as CRP values were increased (P = 0.004 and P < 0.0001, respectively); beta-blocker use was less frequent (P = 0.04), while spironolactone use was more frequent (P = 0.03). The overall survival was reduced in the PE group compared with controls (P = 0.02). Patients with PE were more likely to suffer cardiovascular death (1-year estimated event-free survival: 86 ± 5 vs. 95 ± 1%; P = 0.01) and to require heart transplantation (1-year estimated event-free survival: 88 ± 4 vs. 95 ± 1%; P = 0.009). A multivariate Cox proportional hazard model revealed the following independent predictors of mortality: (a) PE (P = 0.04, hazard ratio (HR): 1.95, 95% confidence interval (CI): 1.0-3.7), (b) age (P = 0.04, HR: 1.02, 95% CI: 1.0-1.04) and (c) LVEF <35% (P = 0.03, HR: 1.7, 95% CI: 1.1-2.8). Conclusion In chronic heart failure, even minor PEs are associated with an increased risk of all-cause mortality, cardiac death, and need for transplantation