Development of a risk-score for pericarditis recurrence in patients with a first episode of acute pericarditis

Background/Introduction

Currently we remain uncertain about which patients are at increased risk for recurrent pericarditis.

Purpose

We developed a risk score for pericarditis recurrence in patients with acute pericarditis.

Methods

We prospectively recruited 262 patients with acute pericarditis. Patients' demographics, clinical, imaging and laboratory data at presentation, were collected. Patients were followed-up for a median of 51 months (interquartile range 21–71) for recurrence. Variables with <10% missingness were entered into multivariable logistic regression models with stepwise elimination to explore independent predictors of recurrence. The performance of the final model was assessed by the c-index and model's calibration and the optimism corrected c-index were evaluated after 10-fold cross-validation.

Results

We identified six independent predictors for pericarditis recurrence i.e., age, effusion size, platelet count (negative predictors) and reduced inferior vena cava collapse, in-hospital use of corticosteroids, and heart rate (positive predictors). The final model had good performance for recurrence, c-index 0.783 (95% CI 0.725–0.842), while the optimism corrected c-index after cross-validation was 0.752. Based on these variables we developed a risk score point system for recurrence (0–22 points) with equally good performance (c-index 0.740, 95% CI 0.677–0.803). Patients with a low score (0–7 points) had 21.3% risk for recurrence, while those with high score (≥12 points) had a 69.8% risk for recurrence (Figure 1). The score was predictive of recurrence among most patient subgroups.

Conclusions

A simple risk score point system based on 6 variables can be used to predict the individualized risk for pericarditis recurrence among patients with a first episode of acute pericarditis.

Funding Acknowledgement

Type of funding sources: None. Figure 1

Pericardiocentesis vs conservative management in patients with asymptomatic, chronic, large, idiopathic, C-reactive negative pericardial effusion

Background/Introduction

Pericardial effusion (PE) prognosis largely depends on the underlying etiology.

Purpose

We sought to assess the outcome of patients with asymptomatic, chronic (>3 months), large (diastolic echo-free space >2 cm), idiopathic (without apparent etiology), C-reactive protein (CRP) negative PE, undergoing either pericardiocentesis or conservative management.

Methods

A total of n=61 patients aged 66.8±15.6 years (women n=32, 53%) were enrolled in this study. Patients were treated by pericardiocentesis (n=39) or conservatively (n=22) at the discretion of treating physician and personal preference. The median follow-up was 24 months (interquartile range: 15 to 36).

Results

Among those patients undergoing pericardiocentesis, PE re-accumulation (any) occurred in 30 cases (76.9%) with large re-accumulation occurring in 41% of patients. Patients with re-accumulation had higher baseline maximum PE diameter (30±1.5mm vs. 25±1.5mm, p=0.02). In patients managed conservatively effusion size remained overall stable in 17 cases (77%), regressed in 3 cases (14%) and increased leading to near or overt tamponade in 2 cases (9,1%). Complicated course occurred in 5 cases (12.8%) of patients undergoing pericardiocentesis [4 cases of cardiac tamponade (10.2%) and 1 recurrent pericarditis] and in 2 conservatively treated patients (cardiac tamponade). Notably, pericardiocentesis was not helpful in establishing new diagnoses and guide treatment. The complications free survival rate was not significantly different between patients undergoing pericardiocentesis and those treated conservatively (long rank chi2=0.504, p=0.478) (Figure 1).

Conclusions

In conclusion, in asymptomatic patients with chronic, large, hemodynamically irrelevant, CRP negative, idiopathic PE, conservative management seems a more reasonable approach in most cases.

Funding Acknowledgement

Type of funding sources: None. Figure 1

Emergency bedside echocardiography as a tool for early detection and clinical decision making in cases of suspected pulmonary embolism--a case report

Massive pulmonary embolism (PE) constitutes the most unexpected cause of death in necropsy. Consequently, prompt diagnosis and treatment is considered imperative. This article reports the case of a 37-year-old man who presented with cardiogenic shock due to PE as detected with bedside echocardiography in the emergency department. The authors wish to emphasize the usefulness of emergency bedside echo-Doppler for a prompt diagnosis and treatment of this life threatening condition.

Ruptured aneurysm of the sinus of Valsalva associated with an atrial septal aneurysm

Aneurysm of the sinus of Valsalva (ASV) is a rare cardiac disease that may be acquired or congenital. It is usually an asymptomatic condition; however, when it ruptures, symptoms appear and the condition deteriorates rapidly. Atrial septal aneurysm (ASA) is a localized "saccular" deformity of the interatrial septum that is associated with cerebrovascular events of embolic origin. We will report on a case of a 69-year-old woman who was referred to our department because of congestive heart failure. Echocardiographic evaluation, both transthoracic and transesophageal, disclosed a ruptured aneurysm of the right sinus of Valsalva into the right atrium (RA), which was associated with an aneurysm of the atrial septum.

Tissue Doppler echocardiography contribution to the diagnosis of upper extremities venous thrombosis

We present the case of a 35-year-old man with a history of beta-thalassemia complicated with heart failure who was admitted to our department because of right arm painful swelling. A transthoracic echo-Doppler study revealed a mass within the right jugular vein (RJV) lumen and absence of flow within the right subclavian vein (RSV). Subsequently, color tissue Doppler echocardiography clearly demonstrated the intraluminal mass by means of its different color hues as compared with the surrounding vessel wall, further enforcing the suspicion of upper extremity vein thrombosis (UEVT). It is emphasized that tissue Doppler echocardiography, a safe and reproducible method, can contribute to the diagnosis of UEVT.

[Acute hepatic ischemia and cardiogenic shock in patients with dilated cardiomyopathy]

A sharp and unusually high increase in the serum of glutamic-oxalacetic and glutamic-pyruvic transaminase and of lactic-dehydrogenase accompanied the terminal events, acute pulmonary edema with cardiogenic shock, in 2 patients suffering from chronic congestive heart failure caused by dilatative myocardiopathy. Experimental and clinical data raises the possibility that the considerable enzymic increase may be due to the combined effect of chronic stasis and acute ischemia on the liver.