Abstract：
Few clinical decision rules have been used to guide clinical management and predict outcomes in patients with pericardial tamponade. The objectives of this study are to identify the echocardiographic features associated with adverse outcomes in patients with pericardial effusions requiring pericardiocentesis and to apply a previously described four-point clinical and echocardiographic score to predict clinical outcomes over 24-hr, 30-day, and 1-year intervals. We performed a retrospective cohort review of patients who had transthoracic echocardiogram (TTE) performed and underwent pericardiocentesis within 48 h of emergency department presentation at two large tertiary care institutions. We constructed different stepwise logistic regression models and examined the associations of TTE characteristics and clinical features with ICU admission, hospital length of stay (h-LOS), and survival. The data set was then employed against a previously proposed scoring system to predict factors associated with clinical outcomes over 24 hr, 30 days, and 1 year. Two hundred thirty-nine patients were included in the final analysis. Echocardiographic characteristics of patients with pericardial tamponade who underwent pericardiocentesis are as follows: 69.1% right ventricular (RV) diastolic collapse, 62.3% exaggerated mitral valve (MV) inflow velocities, 56.4% inferior vena cava (IVC) plethora, and 53.4% right atrial (RA) systolic collapse. Increase in systolic blood pressure and increased variation in MV inflow velocity were associated with reduced ICU admission [OR: 0.94 (CI 0.90, 0.99), 0.28 (CI 0.09, 0.89), respectively]. In addition, a history of malignancy increased the length of hospital stay by about 3.89 days (CI 1.43-6.35, p < 0.01) and prior pericardiocentesis history was associated with 4.82-day increase in hospital stay (CI 1.19-8.45, p = 0.01). In utilizing the previously published prediction score, we found no statistically significant correlation in predicting survival. RV diastolic collapse and exaggerated MV inflow velocity were the most common echocardiographic findings in patients requiring pericardiocentesis. Contrary to prior studies, exaggerated MV inflow velocity was associated with reduced ICU admission. In addition, a previously described prediction score did not correlate with decreased survival in this cohort.
摘要：
很少有临床决策规则用于指导心包填塞患者的临床管理和预测结果。这项研究的目的是确定与需要心包穿刺术的心包积液患者的不良结局相关的超声心动图特征，并应用先前描述的四点临床和超声心动图评分来预测24小时内的临床结局。30天,和1年的间隔。我们对在两个大型三级护理机构急诊就诊后48小时内进行了经胸超声心动图（TTE）检查并接受心包穿刺术的患者进行了回顾性队列研究。我们构建了不同的逐步逻辑回归模型，并检查了TTE特征和临床特征与ICU入院的相关性。住院时间（h-LOS），和生存。然后将数据集用于先前提出的评分系统，以预测24小时内与临床结果相关的因素。30天,和1年。最终分析中包括了两百三十九名患者。心包填塞患者接受心包穿刺术的超声心动图特征如下:69.1%右心室(RV)舒张期塌陷,62.3%增大的二尖瓣(MV)流入速度,56.4%下腔静脉（IVC）过多，和53.4％的右心房（RA）收缩期塌陷。收缩压升高和MV流入速度变化增加与ICU入院减少相关[OR:0.94(CI0.90,0.99),0.28（CI0.09，0.89），分别]。此外,恶性肿瘤病史可使住院时间延长约3.89天(CI1.43~6.35,p<0.01),既往心包穿刺术史与住院时间延长4.82天相关(CI1.19~8.45,p=0.01).在利用先前发布的预测分数时，我们发现在预测生存率方面没有统计学上显著的相关性.在需要心包穿刺术的患者中，最常见的超声心动图发现是RV舒张期塌陷和MV流入速度过高。与以前的研究相反，增大的MV流入速度与ICU入院减少有关。此外,先前描述的预测评分与该队列的生存率降低无关.
