Predictors of Recurrent Large Pericardial Effusion Requiring Pericardiocentesis in Cancer Patients
Presenter
Talha Ahmed, M.D., University of Texas at Health Science Center, Houston, TX
Talha Ahmed, M.D.1, Nicolas Palaskas, MD2, Juan C. Lopez-Mattei, M.D.3, Peter Y Kim, M.D.4 and Cezar A. Iliescu, MD, FSCAI3, (1)University of Texas at Health Science Center, Houston, TX, (2)MD Anderson Cancer Center, Cardiology, Houston, TX, (3)The University of Texas MD Anderson Cancer Center, Houston, TX, (4)Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX
Keywords: Cardio-oncology
Large and symptomatic pericardial effusions (PE) can complicate various malignancies and have increased incidence in specific patient subsets. We sought to evaluate the factors determining recurrence in these patients.
All data pertaining pericardiocentesis (PC) for large PE in cancer patient population performed and enrolled over a decade 2010-2020 in a Cancer Center Pericardiocentesis Registry were analyzed. Descriptive statistics were done to report mean and standard deviation for various variables and Kaplan-Meyer curves were used to analyze survival.
Of the total 469 patients who had PC, 54 (11.5 %) patients had recurrent PE. Mean age of the patient cohort was 48 ± 16.5 years. All patients met the criteria for large PE by echocardiography while 50/54 (92.5 %) had clinical and echocardiographic signs of tamponade at initial PC. Recurrent effusion occurred after mean of 80.5 ± 185 days. Advanced stage (III and IV) solid malignancies were present in 35/54 (65 %) while 19/54 (35 %) had hematological cancers. Recurrence of PE was observed most commonly in lung and breast cancer patients with a cumulative percentage of 37 % (20/54). Laboratory data showed mean hemoglobin of 10.4 ± 1.97 g/dl, platelet count of 195 ± (126) K/uL, INR of 1.23 ± 0.2, and creatinine of 0.88 ± 0.3 mg/dl. PC was performed with subxiphoid approach in 37/54 (68.5 %) and lateral approach in 17/54 (31.5 %) patients. The drain was kept for 4.3 ±1.7 days after initial and 4.8 ±1 days after subsequent PC. Pericardial fluid analysis showed malignant in 42/54 (77.7%) and inflammatory effusion in 12/54 (23.3 %) patients after initial PC. In 13/54 (24 %) patients, anti-inflammatory drugs (NSAIDs or colchicine) were used due to inflammatory nature of effusion either clinically or by analysis of fluid. Mortality at 9 months from the time of initial PC was 43/54 (79.6 %) and was driven by underlying malignancy and treatment related complications (sepsis and renal failure).
Patients with advanced stage cancer (especially lung and breast) are more likely to present with recurrent pericardial effusion and tamponade. Pericardiocentesis appears to have a palliative role in this population with increased disease and treatment-related mortality.