Pericardial effusion unrelated to surgery is a predictor of mortality in heart transplant patients.

ABSTRACT

BACKGROUND: Hemodynamically irrelevant pericardial effusion (PeEf) is a predictor of adverse outcome in heart failure patients. The clinical relevance of a PeEf unrelated to surgery in heart transplant patients remains unknown. This study assesses the prognostic value of PeEf occurring later than 1 year after transplantation. METHODS: All patients undergoing heart transplantation in Zurich between 1989 and 2012 were screened. Cox proportional hazard models were used to analyze mortality (primary) and hospitalization (secondary endpoint). PeEf time points were compared to baseline for rejection, immunosuppressants, tumors, inflam-mation, heart failure, kidney function, hemodynamic, and echocardiographic parameters. RESULTS: Of 152 patients (mean age 48.3 ± 11.9), 25 developed PeEf. Median follow-up period was 11.9 (IQR 5.8-17) years. The number of deaths was 6 in the PeEf group and 46 in the non-PeEf group. The occurrence of PeEf was associated with a 2.5-fold increased risk of death (HR 2.49, 95% CI 1.02-6.13, p = 0.046) and hospitalization (HR 2.53, 95% CI 1.57-4.1, p = 0.0002). CONCLUSIONS: This study reveals that the finding of hemodynamically irrelevant PeEf in heart trans-plant patients is a predictor of adverse outcome, suggesting that a careful clinical assessment is war-ranted in heart transplant patients exhibiting small PeEf.