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


Stämpfli, Simon F; Özkartal, Tardu; Hagenbuch, Niels; Bernhart, Stephan; Flammer, Andreas J; Vecchiati, Alessandra; Fröhlich, Georg M; Ruschitzka, Frank; Held, Leonhard; Tanner, Felix C (2018). Pericardial effusion unrelated to surgery is a predictor of mortality in heart transplant patients. Cardiology Journal:Epub ahead of print.

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 one year after transplantation. METHODS All patients undergoing heart transplantation in Zurich between 1989 and 2012 were screened. Cox proportional hazard models were used to analyse mortality (primary) and hospitalization (secondary endpoint). PeEf time points were compared to baseline for rejection, immunosuppressants, tumours, 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.

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 one year after transplantation. METHODS All patients undergoing heart transplantation in Zurich between 1989 and 2012 were screened. Cox proportional hazard models were used to analyse mortality (primary) and hospitalization (secondary endpoint). PeEf time points were compared to baseline for rejection, immunosuppressants, tumours, 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.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:17 January 2018
Deposited On:31 Jan 2018 16:35
Last Modified:30 Apr 2018 04:02
Publisher:Wydawnictwo Via Medica
ISSN:1898-018X
OA Status:Gold
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.5603/CJ.a2018.0001
PubMed ID:29341061

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