Abstract
Chronic pericardial effusion is a common pericardial syndrome whose approach has been
well-standardized in recent years. The main challenge associated with this condition
is the progression (sometimes unheralded) to cardiac tamponade Pericardial effusions
may present either as an isolated finding or in the context of a specific etiology
including autoimmune, neoplastic, and metabolic diseases. Among investigations used
during diagnostic work-up echocardiography is of paramount importance for the diagnosis,
sizing, and serial evaluation of the hemodynamic impact of effusions on heart diastolic
function. In an individualized manner, advanced imaging including computed tomography
and cardiac magnetic resonance imaging should be performed, especially if baseline
tests are inconclusive. Triage of these patients according to the most recent 2015
European Society of Cardiology Guidelines for the diagnosis and management of pericardial
diseases should take into account the presence of hemodynamic compromise or suspicion
of malignant pericarditis as a first step, C-reactive protein serum level measurement
as second step, investigations for a specific condition known to be associated with
pericardial effusion as third step and finally the size and the duration of the effusion.
Treatment depends on the evaluation of the above-mentioned parameters and should ideally
be tailored to individual patient. Prognosis of chronic pericardial effusions depends
largely on the underlying etiology. According to novel data the prognosis of individuals
with idiopathic, chronic (>3 months), large (>2cm), asymptomatic pericardial effusions
is usually benign and watchful waiting strategy seems more reasonable and cost-effective
compared to routine drainage which was previously suggested.
Key words
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References
- Clinical practice. Acute pericarditis.N Engl J Med. 2014; 371: 2410-2416
- 2015 ESC Guidelines for the diagnosis and management of pericardial diseases.Eur Heart J. 2015; 36: 2921-2964
- Pericardial Effusion and Cardiac Tamponade in the New Millennium.Curr Cardiol Rep. 2017; 19: 57
- Contemporary management of pericardial effusion.Panminerva Med. 2021; 63: 288-300
- New Approaches to Management of Pericardial Effusions.Curr Cardiol Rep. 2021; 23: 106
- Controversial issues in the management of pericardial diseases.Circulation. 2010; 121: 916-928
- The landscape of acute pericarditis in Greece: Experience from a tertiary referral center.Hellenic J Cardiol. 2019; 60: 139-140
- Medical history of the pericardium. The hairy hearts of hoary heroes.Am J Cardiol. 1970; 26: 447-454
- Pericardial Thickness Measured With Transesophageal Echocardiography: Feasibility and Potential Clinical Usefulness.J Am Coll Cardiol. 1997; 29: 1317-1323
- Physiology of pericardial fluid production and drainage.Front Physiol. 2015; 6: 62
- Pericardial disease--anatomy and function.Br J Radiol. 2011; 84
- Chronic pericardial effusion: current concepts and emerging trends.Expert Rev Cardiovasc Ther. 2022; 20: 363-376
- Pericardium of rodents: pores connect the pericardial and pleural cavities.Anat Rec. 1988; 220: 132-137
- Pericardial and pleural effusions in congestive heart failure-anatomical, pathophysiologic, and clinical considerations.Am J Med Sci. 2009; 338: 211-216
- Case series, contemporary review and imaging guided diagnostic and management approach of congenital pericardial defects.Open Heart. 2020; 7e001103
- Triage and management of pericardial effusion.J Cardiovasc Med (Hagerstown). 2010; 11: 928-935
- A small pericardial effusion is a marker of increased mortality.Am Heart J. 2011; 161: 152-157
- Misclassification of Pericardial Disease Diagnosis; International Classification of Diseases-10 Coding Requires Validation.Circulation. 2019; 140A15826
- Age- and sex-based differences in patients with acute pericarditis.Eur J Clin Invest. 2021; 51e13392
- Percutaneous pericardiocentesis for pericardial effusion: predictors of mortality and outcomes.Intern Emerg Med. 2021; 16: 1771-1777
- Should pericardial drainage be performed routinely in patients who have a large pericardial effusion without tamponade?.Am J Med. 1998; 105: 106-109
- Long-Term Outcome of Pericardial Drainage in Cases of Chronic, Large, Hemodynamically Insignificant, C-Reactive Protein Negative, Idiopathic Pericardial Effusions.Am J Cardiol. 2020; 126: 89-93
- Myocarditis and Pericarditis After COVID-19 mRNA Vaccination: Practical Considerations for Care Providers.Can J Cardiol. 2021; 37: 1629-1634
- Coronavirus Disease 2019 (COVID-19) and Severe Pericardial Effusion: From Pathogenesis to Management: A Case Report Based Systematic Review.Curr Probl Cardiol. 2022; 47100933
- Management of pericardial effusion.Eur Heart J. 2013; 34: 1186-1197
- What is the normal composition of pericardial fluid?.Heart. 2021; 107: 1584-1590
- Outcomes of idiopathic chronic large pericardial effusion.Heart. 2019; 105: 477-481
- Contemporary management of pericardial effusion: practical aspects for clinical practice.Postgrad Med. 2017; 129: 178-186
- American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease.J Am Soc Echocardiogr. 2013; 26: 965-1012.e15
- European Association of Cardiovascular Imaging (EACVI) position paper: Multimodality imaging in pericardial disease.Eur Heart J Cardiovasc Imaging. 2015; 16: 12-31
- Imaging-Guided Therapies for Pericardial Diseases.JACC Cardiovasc Imaging. 2020; 13: 1422-1437
- Management of Acute and Recurrent Pericarditis: JACC State-of-the-Art Review.J Am Coll Cardiol. 2020; 75: 76-79
- Diagnostic value of pericardial biopsy: improvement with extensive sampling enabled by pericardioscopy.Circulation. 2003; 107: 978-983
- The Value of Cytology in the Evaluation of Malignant Pericardial Effusions: A Systematic Review.Diagnostics (Basel). 2022; 12: 367
- The role of18F-fluorodeoxyglucose-positron emission tomography/computed tomography in the differential diagnosis of pericardial disease.Sci Rep. 2020; 1021524
- The role of multimodality imaging in the management of pericardial disease.Circ Cardiovasc Imaging. 2010; 3: 333-343
- Cardiac tamponade: an educational review.Eur Heart J Acute Cardiovasc Care. 2020 Jul 6; 2048872620939341
- Pericardiocentesis by Real-Time Echo-Monitored Procedure.Am J Cardiol. 2016; 117: 1369-1374
- Epicardial halo phenomenon: a guide for pericardiocentesis?.Heart Fail Rev. 2013; 18: 307-316
- Computed tomography-guided pericardiocentesis - a single-center experience.Rev Port Cardiol. 2016; 35: 285-290
- Triage strategy for urgent management of cardiac tamponade: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases.Eur Heart J. 2014; 35: 2279-2284
- Recurrence of Pericardial Effusion After Pericardiocentesis: Does Catheter-Induced Acute Pericardial Inflammation Play a Role?.Am J Med Sci. 2021; 361: 676-678
- Pericardial decompression syndrome: A comprehensive review.World J Cardiol. 2019; 11: 282-291
- Pericardial decompression syndrome: a rare but potentially fatal complication of pericardial drainage to be recognized and prevented.Eur Heart J Acute Cardiovasc Care. 2015; 4: 121-123
- Metastatic cardiac tumors: from clinical presentation through diagnosis to treatment.BMC Cancer. 2018; 18: 202
- Guidelines on the diagnosis and management of pericardial diseases executive summary.Eur Heart J. 2004; 25: 587-610
- The usefulness of diagnostic tests on pericardial fluid.Chest. 1997; 111: 1213-1221
- Bloody pericardial effusion in patients with cardiac tamponade: is the cause cancerous, tuberculous, or iatrogenic in the 1990s?.Chest. 1999; 116: 1564-1569
- Pericarditis and pericardial effusion: one or two distinct diseases?.Minerva Cardiol Angiol. 2022; 70: 207-216
- Effect of Anti-Inflammatory Drugs on Clinical Outcomes in Patients With Malignant Pericardial Effusion.J Am Coll Cardiol. 2020; 76: 1551-1561
- Clinical clues to the causes of large pericardial effusions.Am J Med. 2000; 109: 95-101
- Etiology of large pericardial effusions.Am J Med. 1993; 95: 209-213
- Acute cardiac tamponade.N Engl J Med. 2003; 349: 684-690
- Pericardial disease.Circulation. 2006; 113: 1622-1632
- Pericardial disease: diagnosis and management.Mayo Clin Proc. 2010; 85: 572-593
- Long-term follow-up of idiopathic chronic pericardial effusion.N Engl J Med. 1999; 341: 2054-2059
- Outcomes of clinically significant idiopathic pericardial effusion requiring intervention.Am J Cardiol. 2003; 91: 704-707
- Contemporary biochemical analysis of normal pericardial fluid.Heart. 2020; 106: 541-544
- Risk factors affecting the survival of patients with pericardial effusion submitted to subxiphoid pericardiostomy.Chest. 2003; 124: 242-246
- Haemodynamically irrelevant pericardial effusion is associated with increased mortality in patients with chronic heart failure.Eur Heart J. 2013; 34: 1414-1423
- ESC/ERS Scientific Document Group. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension.Eur Heart J. 2022; 43: 3618-3731
- Is pericardial effusion a negative prognostic marker? Meta-analysis of outcomes of pericardial effusion.J Cardiovasc Med (Hagerstown). 2019; 20: 39-45
- Recent advances in pericarditis.Eur J Intern Med. 2022; 95: 24-31
- The prognostic impact of the 2015 European Society of Cardiology pericarditis guidelines implementation in clinical practice.Hellenic J Cardiol. 2022; 64: 97-98
- Untying the Gordian knot of pericardial diseases: A pragmatic approach.Hellenic J Cardiol. 2016; 57: 315-322
- 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease.Eur Heart J. 2021; 42: 17-96
- Pericardial involvement in systemic inflammatory diseases.Heart. 2011; 97: 1882-1892
Article info
Publication history
Accepted:
February 1,
2023
Received in revised form:
January 10,
2023
Received:
December 11,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Disclosures: Nothing to declare
Funding Sources: None
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
