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Original research
Contemporary biochemical analysis of normal pericardial fluid
  1. Massimo Imazio1,
  2. Andrea Biondo2,
  3. Davide Ricci3,
  4. Massimo Boffini3,
  5. Emanuele Pivetta4,
  6. Antonio Brucato5,
  7. Carla Giustetto1,6,
  8. Gaetano Maria De Ferrari1,6,
  9. Mauro Rinaldi3
  1. 1 University Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, Torino, Italy
  2. 2 Cardiovascular and Thoracic Department, University of Torino, Torino, Italy
  3. 3 Cardiac Surgery, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, Torino, Italy
  4. 4 Emergency Medicine and High Dependency Unit, Cancer Epidemiology Unit and CPO Piemonte, Department of Medical Sciences, University of Torino, AOU Città della Salute e della Scienza di Torino, Torino, Italy
  5. 5 Dipartimento di Scienze Biomediche e Cliniche 'Sacco', University of Milano, Milano, Italy
  6. 6 Department of Medical Sciences, University of Torino, Torino, Italy
  1. Correspondence to Massimo Imazio, University Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, Torino 10141, Italy; massimo_imazio{at}yahoo.it; massimo.imazio{at}unito.it

Abstract

Objective Biochemical analysis of pericardial fluid (PF) is commonly performed for the initial assessment of PF, and the results are usually interpreted according to Light’s traditional criteria for the differential diagnosis of transudates versus exudates. However, Light’s criteria have been formulated for the biochemical analysis of pleural fluid. The aim of the present paper is to evaluate the normal composition of PF in candidates for cardiac surgery.

Methods Cohort study with analysis of PF from candidates for cardiac surgery. Exclusion criteria were previous pericardial disease or cardiac surgery, prior myocardial infarction within 3 months, systemic disease (eg, systemic inflammatory diseases, uremia) or drug with potentiality to affect the pericardium.

Results Fifty patients (mean age was 67 years; 95% CI 64 to 71, 29 males, 58.0%) were included in the present analysis. Levels of small molecules were similar in blood and PF. Total proteins in PF was, on average, 0.5 times lower than corresponding plasma levels (p=0.041), while the level of pericardial lactate dehydrogenase was, on average, 1.06 times higher than plasma (p=0.55). Moreover, mononuclear cells were more concentrated in PF than plasma (p=0.17). Traditional Light’s criteria misclassified all PFs as exudates.

Conclusions Traditional Light’s criteria misclassified normal PFs in candidates for cardiac surgery as exudates. This study suggests their futility for the biochemical analysis of PF in clinical practice.

  • pericardial fluid
  • biochemical analysis
  • transudate
  • exudate
  • diagnosis

https://doi.org/10.1136/heartjnl-2018-314574

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    Footnotes

    • Contributors All authors have participated and contributed to the manuscript providing a final approval for submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Ethics approval Ethical Committee—AOU Città della Salute e della Scienza di Torino.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.