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Effects of Pericardiocentesis on Renal Function and Cardiac Hemodynamics
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  • Maulin Shah,
  • Hezzy Shmueli,
  • Yatindra Patel,
  • Long-Co Nguyen,
  • Hannah Hardy,
  • Florian Rader,
  • Robert J. Siegel
Maulin Shah
Cedars-Sinai Medical Center Smidt Heart Institute
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Hezzy Shmueli
Soroka Medical Center
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Yatindra Patel
Cedars-Sinai Medical Center Medicine Department
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Long-Co Nguyen
Cedars-Sinai Medical Center Medicine Department
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Hannah Hardy
Cedars-Sinai Medical Center Smidt Heart Institute
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Florian Rader
Cedars-Sinai Medical Center Smidt Heart Institute
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Robert J. Siegel
Cedars-Sinai Medical Center Smidt Heart Institute

Corresponding Author:[email protected]

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Abstract

Background: Previous case studies have reported reversal of acute renal failure after pericardiocentesis in pericardial effusion. This study examines the effects of pericardiocentesis on pre-procedural low cardiac output and acute renal dysfunction in patients with pericardial effusion. Methods: This is a retrospective study of 95 patients undergoing pericardiocentesis between 2015 and 2020. Pre- and post-procedure transthoracic echocardiograms (TTE) were reviewed for evidence of cardiac tamponade, resolution of pericardial effusion, and for estimation of right atrial (RA) pressure and cardiac output. Laboratory values were compared at presentation and post-procedure. Patients on active renal replacement therapy were excluded. Results: Ninety-five patients were included for analysis (mean age 62.2±17.8 years, 58% male). There was a significant increase in glomerular filtration rate pre- and post-procedure. Fifty-six patients (58.9%) had an improvement in glomerular filtration rate after pericardiocentesis (termed “responders”), and these patients had a lower pre-procedure glomerular filtration rate than “non-responders”. Forty-four patients (46.3%) had a greater than 10% improvement in glomerular filtration rate. There was a significant improvement in estimated cardiac output and right atrial pressure for patients in both groups. Patients who had an improvement in renal function had significantly lower pre-procedural diastolic blood pressure and mean arterial pressure. Conclusions: Pericardial drainage may improve effusion-mediated acute renal dysfunction by reducing right atrial pressure and thus systemic venous congestion, and by increasing forward stroke volume and perfusion pressure.
06 Jul 2023Submitted to Echocardiography
06 Jul 2023Submission Checks Completed
06 Jul 2023Assigned to Editor
17 Jul 2023Reviewer(s) Assigned
18 Aug 2023Review(s) Completed, Editorial Evaluation Pending
30 Aug 2023Editorial Decision: Revise Major
14 Oct 20231st Revision Received
16 Oct 2023Submission Checks Completed
16 Oct 2023Assigned to Editor
16 Oct 2023Reviewer(s) Assigned