title: Differential Impact of Constrictive Physiology after Pericardiocentesis in Malignancy Patients with Pericardial Effusion.
abstract: BACKGROUND
  Echocardiographic signs of constrictive physiology (CP) after pericardiocentesis are frequently observed in malignancy patients. The purpose of the current study was to explore whether features of CP after pericardiocentesis have prognostic impact in malignancy patients with pericardial effusion (PE).
  
  
  METHODS
  We retrospectively reviewed 467 consecutive patients who underwent pericardiocentesis at our institution from January 2006 to May 2014. Among them, 205 patients with advanced malignancy who underwent comprehensive echocardiography after the procedure comprised the study population. Co-primary end points were all-cause mortality (ACM) and repeated drainage (RD) for PE. Patients were divided into four subgroups according to cytologic result for malignant cells and CP (positive cytology with negative CP, both positive, both negative, and negative cytology with positive CP).
  
  
  RESULTS
  CP after pericardiocentesis was present in 106 patients (50%) at median 4 days after the procedure. During median follow-up of 208 days, ACM and RD occurred in 162 patients (79%) and 29 patients (14%), respectively. Cox regression analysis revealed that independent predictors for ACM were male gender and positive cytology (all, p < 0.05). For RD, predictors were positive cytology, the absence of cardiac tamponade, and negative CP after pericardiocentesis (all, p < 0.05). When the patients were divided into four subgroups, patients with negative cytology and positive CP demonstrated the most favorable survival (hazard ratio [HR]: 0.39, p = 0.005) and the lowest RD rates (HR: 0.07, p = 0.012).
  
  
  CONCLUSIONS
  CP after pericardiocentesis is common, but does not always imply poor survival or the need for RD in patients with advanced malignancies. On the contrary, the presence of CP in patients with negative cytology conferred the most favorable survival and the lowest rate of RD. Comprehensive echocardiographic evaluation for CP after pericardiocentesis would be helpful for predicting prognosis in patients with advanced malignancies.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: In-Jeong
authors.initials: IJ
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.|Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hyuk-Jae
authors.initials: HJ
authors.lastname: Chang
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hyemoon
authors.initials: H
authors.lastname: Chung
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sang-Eun
authors.initials: SE
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Chi Young
authors.initials: CY
authors.lastname: Shim
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Geu-Ru
authors.initials: GR
authors.lastname: Hong
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jong-Won
authors.initials: JW
authors.lastname: Ha
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Namsik
authors.initials: N
authors.lastname: Chung
mesh_terms: D000368:Aged; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology; D010490:Pericardial Effusion / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D020519:Pericardiocentesis / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies