Initial echocardiographic characteristics of pericardial effusion determine the pericardial complications

Background: Clinical implications of the initial echocardiographic characteristics of pericardial effusion (PE) have not been clearly demonstrated. We sought to evaluate the clinical significance of echogenic materials in PE. Methods: Echocardiographic evaluation was performed in consecutive 178 patients with moderate to severe PE, and the etiology of PE was determined by clinical and pathologic studies. Echocardiography was repeated for 46 +/- 56 weeks. Results: Echo-free PE was shown in 142 patients (80%, group A), while echogenic PE was found in 36 patients (20%, group B). In group B, intrapericardial fibrinous strands and/or exudative frond-like materials were detected in 29 patients and diffuse echogenic PE was shown in 7 patients. The prevalence of echogenic PE was the highest in tuberculosis (56.3%). All 49 patients with uremia or congestive heart failure showed clear echo-free PE. During the follow-up, the incidence of constrictive pericarditis and recurrent PE were highest in malignancy (38.6%) and tuberculosis (31.3%), respectively. The incidence of constrictive pericarditis (3.5 vs. 27.8%, p < 0.001) and recurrent PE (9.2 vs. 22.2%, p < 0.05) were significantly lower in group A than group B. The echogenic PE was the major independent predictor of the events by multiple stepwise logistic regression analysis (p < 0.01), regardless of the PE etiology. Conclusion: Echogenic materials in PE predict pericardial complications such as recurrence and constrictive pericarditis, irrespective of underlying diseases. (c) 2008 Elsevier Ireland Ltd. All rights reserved.