Background: The purpose of this study was to investigate prognosis of patients with idiopathic pericardial effusion (PE) and identify prognostic factors in Korea that is tuberculosis (TBc)-endemic area.
Methods: Of 672 patients with PE who underwent pericardiocentesis or pericardial window operation between January 1997 and December 2009, 63 (9.4%) (age: 60±15 years, 43 females) were finally diagnosed as idiopathic PE. Initial clinical and laboratory findings were evaluated, and clinical events defined as death, pericardiectomy, and repeated PE drainage were observed for a median of 30 months.
Results: Of 63 patients, 9 were asymptomatic. Non-steroidal anti-inflammatory drugs, colcichine, and empirical anti-TBc medications were used in 5, 1 and 14 patients, respectively. During follow-up period, no mortality was observed. Two patients underwent pericardiectomy after 2.5 and 4.5 months after the day of initial drainage procedure due to development of constrictive pericarditis, and another 2 underwent repeated pericardial window operation. The 4 patients (6.3%) with clinical events showed higher prevalence of hemodynamic significance on the initial echocardiography (40% vs. 3.6%, p=0.031) and lower platelet count (166800±54085 vs. 284844±114527/mm3, p=0.027) than others without clinical events. There was no difference in clinical events between the patients treated with and without anti-TBc medication (7.1% vs. 6.1%, p=0.89). By multivariate Cox proportional hazard model, only independent predictor for clinical events was hemodynamic significance on the initial echocardiography (hazard ratio: 16.675, 95% confidence interval: 1.109 to 250.684). Event-free survival rates were significantly higher in 5 patients with the initial hemodynamic significance than in 56 patients without (Figure, p<0.001).
Conclusion: Idiopathic PE seems to be a benign disease, and hemodynamic significance on the initial echocardiography is a major prognostic factor. Empirical anti-TBc medications may not be justified for these patients in Korea.
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