Abstract：
The presence of pulmonary hypertension (PH) may affect whether cardiac tamponade physiology develops from a pericardial effusion. Specifically, the increased intracardiac pressure and right ventricular hypertrophy associated with PH would seemingly increase the intrapericardial pressure threshold at which the right-sided chambers collapse. In this systematic review, we examined the impact of PH on the incidence, in-hospital and long-term mortality, and echocardiographic findings of patients with cardiac tamponade. Using the PRISMA guideline, a systematic search was conducted in PubMed, Academic Search Premier, Web of Science, Google Scholar, and the Cochrane Database for studies investigating PH and cardiac tamponade. The Newcastle-Ottawa Scale was used to analyze the quality of returned studies. Primary outcomes included the incidence of cardiac tamponade, as well as in-hospital and long-term mortality rates. Secondary outcomes were the presence or absence of echocardiographic findings of cardiac tamponade in patients with PH. Forty-three studies (9 cohort studies and 34 case reports) with 1054 patients were included. The incidence of cardiac tamponade was significantly higher in patients with PH compared to those without PH, 2.0% (95% CI 1.2-3.2%) vs. 0.05% (95% CI 0.05-0.05%), p < 0.0001, OR 40.76 (95% CI 24.8-66.9). The incidence of tamponade in patients with a known pericardial effusion was similar in those with and without PH, 20.3% (95% CI 12.0-32.3%) and 20.9% (95% CI 18.0-24.1%), p = 0.9267, OR 0.97 (95% CI 0.50-1.87). In patients with tamponade, those with PH demonstrated a significantly higher in-hospital mortality than those without PH, 38.8% (95% CI 26.4-52.8%) vs. 14.4% (95% CI 14.2-14.6%), p < 0.0001, OR 3.77 (95% CI 2.12-6.70). Long-term mortality in patients with tamponade was significantly lower in those with PH than in those without PH, 45.5% (95% CI 33.0-58.5%) vs. 59.1% (95% CI 54.7-63.4%), p = 0.0258, OR 0.576 (95% CI 0.33-1.01). However, after stratifying by non-malignant etiologies, the long-term mortality benefit for those with PH disappeared. In the studies that described specific echocardiographic findings of cardiac tamponade, only 10.5% of patients with PH and tamponade showed right atrial and right ventricular collapse. When evaluating patients with pericardial effusions, physicians must recognize the effects of underlying PH on the incidence, in-hospital and long-term mortality rates, and potentially atypical echocardiographic presentation of cardiac tamponade.
摘要：
肺动脉高压（PH）的存在可能会影响心包积液是否会导致心脏压塞生理。具体来说,与PH相关的心内压升高和右心室肥大似乎会增加右侧腔室塌陷时的心包内压阈值.在这次系统审查中，我们检查了PH对发病率的影响，住院和长期死亡率，和心脏填塞患者的超声心动图检查结果。使用PRISMA指南，在PubMed进行了系统的搜索，学术搜索总理，WebofScience,谷歌学者，以及Cochrane数据库，用于研究PH和心脏压塞。纽卡斯尔-渥太华量表用于分析返回研究的质量。主要结果包括心脏填塞的发生率，以及住院和长期死亡率。次要结果是PH患者是否存在心脏压塞的超声心动图检查结果。纳入43项研究（9项队列研究和34例病例报告），共1054例患者。与没有PH的患者相比，PH患者的心脏压塞发生率明显更高，2.0%（95%CI1.2-3.2%）与0.05%（95%CI0.05-0.05%），p<0.0001，OR40.76（95%CI24.8-66.9）。心包积液患者心包填塞的发生率在有和没有PH的患者中相似，20.3%（95%CI12.0-32.3%）和20.9%（95%CI18.0-24.1%），p=0.9267，OR0.97（95%CI0.50-1.87）。在填塞的患者中，患有PH的患者的住院死亡率明显高于没有PH的患者，38.8%（95%CI26.4-52.8%）与14.4%（95%CI14.2-14.6%），p<0.0001，OR3.77（95%CI2.12-6.70）。患有填塞的患者的长期死亡率在患有PH的患者中明显低于没有PH的患者，45.5%（95%CI33.0-58.5%）与59.1%（95%CI54.7-63.4%），p=0.0258，OR0.576（95%CI0.33-1.01）。然而,在按非恶性病因分层后，PH患者的长期死亡率获益消失.在描述心脏填塞的特定超声心动图发现的研究中，只有10.5％的PH和填塞患者出现右心房和右心室塌陷。在评估心包积液患者时，医生必须认识到潜在的PH对发病率的影响，住院和长期死亡率，和潜在的不典型的心脏填塞超声心动图表现。
