Correlation between clinical and Doppler echocardiographic findings in patients with moderate and large pericardial effusion: Implications for the diagnosis of cardiac tamponade

doi:10.1016/S0002-8703(99)70193-6

American Heart Journal

Volume 138, Issue 4, October 1999, Pages 759-764

https://doi.org/10.1016/S0002-8703(99)70193-6 Get rights and content

Abstract

Background Clinical data are of unquestionable value for management purposes in cardiac tamponade, whereas the precise value of Doppler echocardiographic findings is not yet fully understood. We aimed to prospectively assess the correlation between clinical and Doppler echocardiographic signs in the diagnosis of cardiac tamponade in a large series of patients with pericardial effusion. Methods During a 2-year period, all patients with moderate and large pericardial effusion were prospectively assessed. The presence of clinical findings suggesting cardiac tamponade, right cardiac chamber collapse on the echocardiogram, and Doppler venous flow pattern were simultaneously evaluated. Results One hundred ten patients were included (49 with moderate and 61 with large effusions). Thirty-eight patients showed clinical features suggestive of cardiac tamponade and 72 did not. In patients with clinical tamponade, 90% had collapse of one or more right cardiac chambers, but 4 (10%) did not have any collapse. Venous flow was analyzable in 63%, suggesting tamponade in 75% of the patients. In patients without clinical tamponade, 34% showed collapse of one or more cardiac chambers. Venous flow pattern was normal in 80%, inconclusive in 11%, and only suggestive of tamponade in 9% of patients. If clinical features of tamponade were considered the diagnostic standard, sensitivity and specificity would be 90% and 65% for the presence of any collapse, 68% and 66% for right atrial collapse, 60% and 90% for right ventricular collapse, and 45% and 92% for simultaneous collapse of both chambers. Sensitivity and specificity of venous flow analysis would be 75% and 91%, respectively. Conclusions There is a good correlation between absence of collapse and absence of tamponade, but the correlation is poor between collapse and tamponade. Abnormal venous flow has a good correlation with clinical features of tamponade, with a higher sensitivity than right ventricular collapse and a much higher specificity than right atrial collapse. (Am Heart J 1999;138:759-64.)

Section snippets

Patients

Between April 1994 and April 1996, all patients admitted to Hospital General Vall d’Hebron in whom a new moderate or large pericardial effusion was diagnosed at the echocardiography laboratory were prospectively assessed. All echocardiographic reports from the laboratory were assessed on a daily basis. Moderate pericardial effusion was considered to be present when the sum of diastolic echo-free anterior and posterior spaces was 10 to 20 mm and large when it was greater than 20 mm.⁶

Clinical data

Cardiac

Results

Moderate or large pericardial effusion was diagnosed in 120 patients (66 males and 54 females; age range, 15-88 years; mean age, 53 years). Effusion was moderate in 52 patients and large in 68.

On the basis of physical findings, 47 patients had cardiac tamponade and 73 did not. Ten patients in whom a complete Doppler echocardiographic recording could not be obtained simultaneously with clinical assessment of tamponade were excluded; 9 patients had features of tamponade and 1 did not.

Discussion

This study is the largest prospective series to have evaluated the correlation between clinical signs and echocardiographic features suggestive of tamponade in patients with pericardial effusion.

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Citation Excerpt :
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^☆: Reprint requests: Jordi Mercé, MD, Secció de Cardiologia, Hospital Universitari de Tarragona Joan XXIII, c/Doctor Mallafrè Guasch 4, 43007 Tarragona, Spain.

^☆☆: 0002-8703/99/$8.00 + 0 4/1/98035

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Correlation between clinical and Doppler echocardiographic findings in patients with moderate and large pericardial effusion: Implications for the diagnosis of cardiac tamponade☆,☆☆

Abstract

Section snippets

Patients

Clinical data

Results

Discussion

Am J Cardiol

Chest

Am Heart J

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Int J Cardiol

J Am Coll Cardiol

Mayo Clin Proc

Am J Cardiol

Am J Med

Am J Cardiol

Two cardiac compression triads

JAMA

Cardiac tamponade in medical patients

Circulation