Vol 25, No 6 (2018)
Original articles — Clinical cardiology
Published online: 2018-01-10

open access

Page views 2972
Article views/downloads 997
Get Citation

Connect on Social Media

Connect on Social Media

Pericardial effusion unrelated to surgery is a predictor of mortality in heart transplant patients

Simon F. Stämpfli1, Tardu Özkartal1, Niels Hagenbuch2, Stephan Bernhart1, Andreas J. Flammer1, Alessandra Vecchiati1, Georg M. Fröhlich1, Frank Ruschitzka1, Leonhard Held2, Felix C. Tanner1
Pubmed: 29341061
Cardiol J 2018;25(6):714-721.

Abstract

Background: Hemodynamically irrelevant pericardial effusion (PeEf) is a predictor of adverse outcome in heart failure patients. The clinical relevance of a PeEf unrelated to surgery in heart transplant patients remains unknown. This study assesses the prognostic value of PeEf occurring later than 1 year after transplantation.

Methods: All patients undergoing heart transplantation in Zurich between 1989 and 2012 were screened. Cox proportional hazard models were used to analyze mortality (primary) and hospitalization (secondary endpoint). PeEf time points were compared to baseline for rejection, immunosuppressants, tumors, inflam­mation, heart failure, kidney function, hemodynamic, and echocardiographic parameters.

Results: Of 152 patients (mean age 48.3 ± 11.9), 25 developed PeEf. Median follow-up period was 11.9 (IQR 5.8–17) years. The number of deaths was 6 in the PeEf group and 46 in the non-PeEf group. The occurrence of PeEf was associated with a 2.5-fold increased risk of death (HR 2.49, 95% CI 1.02–6.13, p = 0.046) and hospitalization (HR 2.53, 95% CI 1.57–4.1, p = 0.0002).

Conclusions: This study reveals that the finding of hemodynamically irrelevant PeEf in heart trans­plant patients is a predictor of adverse outcome, suggesting that a careful clinical assessment is war­ranted in heart transplant patients exhibiting small PeEf.

Article available in PDF format

View PDF Download PDF file

References

  1. Vandenberg BF, Mohanty PK, Craddock KJ, et al. Clinical significance of pericardial effusion after heart transplantation. J Heart Transplant. 1988; 7(2): 128–134.
  2. Quin JA, Tauriainen MP, Huber LM, et al. Predictors of pericardial effusion after orthotopic heart transplantation. J Thorac Cardiovasc Surg. 2002; 124(5): 979–983.
  3. Hauptman PJ, Couper GS, Aranki SF, et al. Pericardial effusions after cardiac transplantation. J Am Coll Cardiol. 1994; 23(7): 1625–1629.
  4. Ciliberto GR, Anjos MC, Gronda E, et al. Significance of pericardial effusion after heart transplantation. Am J Cardiol. 1995; 76(4): 297–300.
  5. Almenar L, Osa A, Martínez-Dolz L, et al. Echocardiographic evaluation of the evolutionary changes after heart transplantation. Transplant Proc. 2006; 38(8): 2575–2576.
  6. Fröhlich GM, Keller P, Schmid F, et al. Haemodynamically irrelevant pericardial effusion is associated with increased mortality in patients with chronic heart failure. Eur Heart J. 2013; 34(19): 1414–1423.
  7. Hinderliter AL, Willis PW, Long W, et al. Frequency and prognostic significance of pericardial effusion in primary pulmonary hypertension. PPH Study Group. Primary pulmonary hypertension. Am J Cardiol. 1999; 84(4): 481–484, A10.
  8. Lang RM, Bierig M, Devereux RB, et al. Chamber Quantification Writing Group, American Society of Echocardiography's Guidelines and Standards Committee, European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005; 18(12): 1440–1463.
  9. Billingham ME, Cary NR, Hammond ME, et al. A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: Heart Rejection Study Group. The International Society for Heart Transplantation. J Heart Transplant. 1990; 9(6): 587–593.
  10. Anderson JR, Cain KC, Gelber RD, et al. Analysis of survival by tumor response. J Clin Oncol. 1983; 1(11): 710–719.
  11. Andersen PK. Repeated assessment of risk factors in survival analysis. Stat Methods Med Res. 1992; 1(3): 297–315.
  12. Team RC. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing. 2016.
  13. Al-Dadah AS, Guthrie TJ, Pasque MK, et al. Clinical course and predictors of pericardial effusion following cardiac transplantation. Transplant Proc. 2007; 39(5): 1589–1592.
  14. Valantine HA, Hunt SA, Gibbons R, et al. Increasing pericardial effusion in cardiac transplant recipients. Circulation. 1989; 79(3): 603–609.
  15. Sun JP, Abdalla IA, Asher CR, et al. Non-invasive evaluation of orthotopic heart transplant rejection by echocardiography. J Heart Lung Transplant. 2005; 24(2): 160–165.
  16. Jemielity M. EuroSCORE is a Predictor of Postoperative Pericardial Effusion following Heart Transplantation. Ann Transplant. 2015; 20: 193–197.
  17. Lund LH, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirty-second Official Adult Heart Transplantation Report--2015; Focus Theme: Early Graft Failure. J Heart Lung Transplant. 2015; 34(10): 1244–1254.
  18. Committee. NYHAC. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels / the Criteria Committee of the New York Heart Association. 9th Edition ed: Little, Brown, Boston 1994.
  19. Rumsfeld JS, Havranek E, Masoudi FA, et al. Cardiovascular Outcomes Research Consortium. Depressive symptoms are the strongest predictors of short-term declines in health status in patients with heart failure. J Am Coll Cardiol. 2003; 42(10): 1811–1817.
  20. Edelmann F, Stahrenberg R, Gelbrich G, et al. Contribution of comorbidities to functional impairment is higher in heart failure with preserved than with reduced ejection fraction. Clin Res Cardiol. 2011; 100(9): 755–764.
  21. Lee TT, Chen J, Cohen DJ, et al. The association between blood pressure and mortality in patients with heart failure. Am Heart J. 2006; 151(1): 76–83.
  22. Fine M. Prognosis and Outcomes of Patients With Community-Acquired Pneumonia. JAMA. 1996; 275(2): 134–141.
  23. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999; 353(9162): 1386–1389.
  24. Granger CB, Goldberg RJ, Dabbous O, et al. Global Registry of Acute Coronary Events Investigators. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med. 2003; 163(19): 2345–2353.
  25. Aranda-Dios A, Lage E, Sobrino JM, et al. Sirolimus experience in heart transplantation. Transplant Proc. 2006; 38(8): 2547–2549.