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. 2015 Dec 21;10(12):e0145461.
doi: 10.1371/journal.pone.0145461. eCollection 2015.

Differential Impact of Constrictive Physiology after Pericardiocentesis in Malignancy Patients with Pericardial Effusion

In-Jeong Cho  1 , Hyuk-Jae Chang  1   2 , Hyemoon Chung  1 , Sang-Eun Lee  1 , Chi Young Shim  1 , Geu-Ru Hong  1 , Jong-Won Ha  1 , Namsik Chung  1
Affiliations

Differential Impact of Constrictive Physiology after Pericardiocentesis in Malignancy Patients with Pericardial Effusion

In-Jeong Cho et al. PLoS One. .

Abstract

Background: Echocardiographic signs of constrictive physiology (CP) after pericardiocentesis are frequently observed in malignancy patients. The purpose of the current study was to explore whether features of CP after pericardiocentesis have prognostic impact in malignancy patients with pericardial effusion (PE).

Methods: We retrospectively reviewed 467 consecutive patients who underwent pericardiocentesis at our institution from January 2006 to May 2014. Among them, 205 patients with advanced malignancy who underwent comprehensive echocardiography after the procedure comprised the study population. Co-primary end points were all-cause mortality (ACM) and repeated drainage (RD) for PE. Patients were divided into four subgroups according to cytologic result for malignant cells and CP (positive cytology with negative CP, both positive, both negative, and negative cytology with positive CP).

Results: CP after pericardiocentesis was present in 106 patients (50%) at median 4 days after the procedure. During median follow-up of 208 days, ACM and RD occurred in 162 patients (79%) and 29 patients (14%), respectively. Cox regression analysis revealed that independent predictors for ACM were male gender and positive cytology (all, p < 0.05). For RD, predictors were positive cytology, the absence of cardiac tamponade, and negative CP after pericardiocentesis (all, p < 0.05). When the patients were divided into four subgroups, patients with negative cytology and positive CP demonstrated the most favorable survival (hazard ratio [HR]: 0.39, p = 0.005) and the lowest RD rates (HR: 0.07, p = 0.012).

Conclusion: CP after pericardiocentesis is common, but does not always imply poor survival or the need for RD in patients with advanced malignancies. On the contrary, the presence of CP in patients with negative cytology conferred the most favorable survival and the lowest rate of RD. Comprehensive echocardiographic evaluation for CP after pericardiocentesis would be helpful for predicting prognosis in patients with advanced malignancies.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Comparison of all combined events according to the presence of constrictive physiology (A), positive cytology (B) and four groups divided by the results of constrictive physiology and cytology.
CP, constrictive physiology.
Fig 2
Fig 2. Comparison of survival (A) and repeated drainage for pericardial effusion (B) according to the presence of constrictive physiology and positive cytology.
CP, constrictive physiology.
Fig 3
Fig 3. Comparison of survival and repeated drainage for pericardial effusion according to the presence of constrictive physiology.
Patients with positive cytology (A, C) and patients with negative cytology (B, D). CP, constrictive physiology.
Fig 4
Fig 4. Comparison of pericardial effusion carcinoembryonic antigen (CEA) and cytokeratin fragment 19 (CYFRA 21–1) tumor markers (A, B) and serum C-reactive protein (C) according to the presence of constrictive physiology and cytology.
CP, constrictive physiology; CEA, carcinoembryonic antigen; CYFRA 21–1, cytokeratin fragment 19; CRP, C-reactive protein.
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