Contemporary Analysis of cardiac Tamponade Etiologies, Treatments, and Outcomes: the CATEO Study

Abstract

Cardiac tamponade is a critical condition resulting from various etiologies, including malignancies, inflammatory conditions and iatrogenic causes. With advances in treatments and changing epidemiology, there is a need to reassess the prevalence, management, and outcomes of pericardial tamponade. This study aimed to evaluate the current prevalence of different etiologies of tamponade, the management, and the clinical outcomes in a cohort of patients admitted to a high-volume Cardiac Intensive Care Unit (CICU). We conducted a retrospective analysis of 87 patients diagnosed with cardiac tamponade (median age 70 years; 51% male). Data on patient demographics, clinical characteristics, etiologies, treatment strategies, and outcomes were collected and analyzed. Malignant tamponade was the predominant etiology, observed in 47% of cases, with lung cancer being the most common. Other etiologies included inflammatory (22%), iatrogenic (20%), idiopathic (9%), and congestive heart failure-related (2%) effusions. The majority of patients (94%) underwent urgent percutaneous pericardiocentesis. Anti-inflammatory therapy was administered in 67% of cases, including NSAIDs (22%), colchicine (46%), steroids (24%) and IL-1 inhibitors (3%), with some patients receiving combination therapy. The 3-month all-cause mortality rate was 29%, with significantly higher mortality observed in patients with malignant effusions compared to non-malignant causes (49% vs. 11%, p<0.001). This study provides valuable insights into the clinical characteristics, management, and outcomes of patients with cardiac tamponade at a high-volume cancer center. Neoplastic pericardial effusion, particularly due to lung cancer, is the leading cause of tamponade in this cohort. Anti-inflammatory therapies were frequently used, but their role in improving outcomes requires further investigation. Mortality remains high, especially among those with malignancy-related effusions.

Keywords: cardiogenic shock; intensive care unit; malignant effusion; pericardial effusion; pericardial tamponade.