Prognostic potential for pericardial effusion in PAH patients

By Eleanor McDermid, Senior medwireNews Reporter

Monitoring pericardial effusion on serial transthoracic echocardiograms (TTEs) provides useful prognostic information in patients with pulmonary arterial hypertension (PAH), research suggests.

New or persistent pericardial effusion predicted worse survival, report Michael Mathier (University of Pittsburgh Medical Center, Pennsylvania, USA) and colleagues. But patients in whom pericardial effusion resolved had outcomes similar to those who never developed the condition.

The researchers say theirs is the first study “to show that pericardial effusion in patients with PAH is dynamic and this change in pericardial effusion over time is prognostically important.”

They add: “This finding is clinically relevant because mostly all patients with PAH undergo TTE as a routine diagnostic test in their clinical care.”

As reported in Echocardiography, the team followed up 200 PAH patients for a median 3.6 years after their first TTE, during which time 106 died. All patients had a second TTE an average of 1 year after the first, and 58 patients had pericardial effusion on baseline and/or follow-up TTE.

Patients who had pericardial effusion at both times were 3.8 more likely to die than those who never had the finding, and those who developed it between the baseline and follow-up TTEs were 2.4 times more likely to die.

But patients in whom pericardial effusion resolved between the first and follow-up TTEs were no more likely to die than those who never had the condition.

Furthermore, the size of the pericardial effusion was prognostic, with a larger size at either TTE equating to a higher risk of death.

The only other significant predictor of mortality was creatinine, with higher levels increasing the likelihood of death. But pericardial effusion remained prognostic after accounting for this and other factors, including age, cardiac output and New York Heart Association functional class.

Patients with pericardial effusion had significantly poorer right heart haemodynamics than the other patients, including significantly higher average right atrial pressure and lower cardiac output. This, say the researchers, is “consistent with the proposed explanation that an elevated mean right atrial pressure in PAH leads to impaired lymphatic and venous drainage and subsequently contributes to the development of a pericardial effusion.”

They conclude: “Our study suggests that pericardial effusion may be a potential marker for assessing patients with PAH over time, but this will need confirmation in larger prospective studies.”

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