PDF(Pubmed)
Abstract：
BACKGROUND: The incidental finding of a pericardial effusion (PE) poses a challenge in clinical care. PE is associated with malignant conditions or severe cardiac disease but may also be observed in healthy individuals. This study explored the prevalence, determinants, course, and prognostic relevance of PE in a population-based cohort.
RESULTS: The STAAB (Characteristics and Course of Heart Failure Stages A/B and Determinants of Progression) cohort study recruited a representative sample of the population of Würzburg, aged 30 to 79 years. Participants underwent quality-controlled transthoracic echocardiography including the dedicated evaluation of the pericardial space. Of 4965 individuals included at baseline (mean age, 55±12 years; 52% women), 134 (2.7%) exhibited an incidentally diagnosed PE (median diameter, 2.7 mm; quartiles, 2.0-4.1 mm). In multivariable logistic regression, lower body mass index and higher NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels were associated with PE at baseline, whereas inflammation, malignancy, and rheumatoid disease were not. Among the 3901 participants attending the follow-up examination after a median time of 34 (30-41) months, PE was found in 60 individuals (1.5%; n=18 new PE, n=42 persistent PE). Within the follow-up period, 37 participants died and 93 participants reported a newly diagnosed malignancy. The presence of PE did not predict all-cause death or the development of new malignancy.
CONCLUSIONS: Incidental PE was detected in about 3% of individuals, with the vast majority measuring <10 mm and completely resolving. PE was not associated with inflammation markers, death, incident heart failure, or malignancy. Our findings corroborate the view of current guidelines that a small PE in asymptomatic individuals can be considered an innocent phenomenon and does not require extensive short-term monitoring.
RESULTS: The STAAB (Characteristics and Course of Heart Failure Stages A/B and Determinants of Progression) cohort study recruited a representative sample of the population of Würzburg, aged 30 to 79 years. Participants underwent quality-controlled transthoracic echocardiography including the dedicated evaluation of the pericardial space. Of 4965 individuals included at baseline (mean age, 55±12 years; 52% women), 134 (2.7%) exhibited an incidentally diagnosed PE (median diameter, 2.7 mm; quartiles, 2.0-4.1 mm). In multivariable logistic regression, lower body mass index and higher NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels were associated with PE at baseline, whereas inflammation, malignancy, and rheumatoid disease were not. Among the 3901 participants attending the follow-up examination after a median time of 34 (30-41) months, PE was found in 60 individuals (1.5%; n=18 new PE, n=42 persistent PE). Within the follow-up period, 37 participants died and 93 participants reported a newly diagnosed malignancy. The presence of PE did not predict all-cause death or the development of new malignancy.
CONCLUSIONS: Incidental PE was detected in about 3% of individuals, with the vast majority measuring <10 mm and completely resolving. PE was not associated with inflammation markers, death, incident heart failure, or malignancy. Our findings corroborate the view of current guidelines that a small PE in asymptomatic individuals can be considered an innocent phenomenon and does not require extensive short-term monitoring.
摘要：
背景：心包积液（PE）的偶然发现对临床护理提出了挑战。PE与恶性病症或严重心脏疾病相关,但也可在健康个体中观察到。这项研究探讨了患病率，决定因素，当然,以及基于人群的队列中PE的预后相关性。
结果：STAAB（心力衰竭A/B阶段的特征和过程以及进展的决定因素）队列研究招募了维尔茨堡人口的代表性样本，30至79岁。参与者接受了质量控制的经胸超声心动图检查，包括对心包空间的专门评估。在基线纳入的4965名个体中(平均年龄，55±12岁；52%的女性），134（2.7%）表现出偶然诊断的PE（中位直径，2.7毫米；四分位数，2.0-4.1毫米）。在多变量逻辑回归中，较低的体重指数和较高的NT-proBNP(N末端B型利钠肽前体)水平与基线时的PE相关,而炎症，恶性肿瘤，和类风湿疾病没有。在中位时间为34（30-41）个月后参加随访检查的3901名参与者中，在60个人中发现了PE（1.5％；n=18个新PE，n=42持久性PE)。在后续期内,37名参与者死亡，93名参与者报告了新诊断的恶性肿瘤。PE的存在并不能预测全因死亡或新恶性肿瘤的发展。
结论：在约3％的个体中检测到偶然的PE，与绝大多数测量<10毫米和完全解决。PE与炎症标志物无关，死亡,突发心力衰竭,或者恶性肿瘤。我们的发现证实了当前指南的观点，即无症状个体中的小PE可以被认为是无辜的现象，不需要广泛的短期监测。
结果：STAAB（心力衰竭A/B阶段的特征和过程以及进展的决定因素）队列研究招募了维尔茨堡人口的代表性样本，30至79岁。参与者接受了质量控制的经胸超声心动图检查，包括对心包空间的专门评估。在基线纳入的4965名个体中(平均年龄，55±12岁；52%的女性），134（2.7%）表现出偶然诊断的PE（中位直径，2.7毫米；四分位数，2.0-4.1毫米）。在多变量逻辑回归中，较低的体重指数和较高的NT-proBNP(N末端B型利钠肽前体)水平与基线时的PE相关,而炎症，恶性肿瘤，和类风湿疾病没有。在中位时间为34（30-41）个月后参加随访检查的3901名参与者中，在60个人中发现了PE（1.5％；n=18个新PE，n=42持久性PE)。在后续期内,37名参与者死亡，93名参与者报告了新诊断的恶性肿瘤。PE的存在并不能预测全因死亡或新恶性肿瘤的发展。
结论：在约3％的个体中检测到偶然的PE，与绝大多数测量<10毫米和完全解决。PE与炎症标志物无关，死亡,突发心力衰竭,或者恶性肿瘤。我们的发现证实了当前指南的观点，即无症状个体中的小PE可以被认为是无辜的现象，不需要广泛的短期监测。
