Prognosticimplicationsof pericardialeffusion inacuteheart failure:Does size matter?

Somedegreeofpericardialeffusion(PE)occurredinupto20%ofpa-tientswithheartfailure(HF)[1].Arecentstudyshowedthatinpatientswithchronicheartfailure(CHF),evenahemodynamicallyirrelevantPEwasassociated withincreasedriskofadverseevents [2,3]. Should thesefindings be extrapolated to patients with AHF? Moreover, the patho-physiology of such association remains to be determined. Thus, thisstudy sought to evaluate the association between PE and the risk of 1-year mortality in patients with AHF.Weincluded1827consecutivepatientsadmittedforAHFintheCar-diology department of a tertiary university hospital from January 2004to July 2013. Patients with a hemodynamically compromised PE wereexcluded (n = 16). In addition, patients with prior cardiac surgery,myocardial infarction, a suspected acute peri/myocarditis within thelast3months,inflammatorysystemicdisease,oranactivecancerwithinthe last year were excluded. A two-dimensional echocardiogram wasperformed in all patients during index hospitalization (96 ± 24 h afteradmission) in the left lateral decubitus position. Two commerciallyavailable systems were used throughout the study (Agilent Sonos5500 and ie33, Philips, Massachusetts, United States of America). Themagnitude of PE was graded as non-PE, mild (I), moderate (II), large(III) and very large (IV), according to current recommendations [4,5].Large and very large PEs were considered to be severe (III/IV). Cox re-gression analysis was used to evaluate the association among PE gradeand the risk of 1-year death. Candidate covariates were chosen basedon previous medical knowledge; then, a backward stepwise selectionwasperformed.Finalmultivariateanalysisincludedallthefollowingco-variates: age, gender, history of heart failure, prior New York Heart As-sociation Functional Class, 30-day prior admission, ischemic etiology,interaction left ventricular systolic function b 50% ∗ systolic blood pres-sure, blood ureic nitrogen, hemoglobin, plasma N-terminal pro-B-typenatriuretic peptide (NT-proBNP), plasma carbohydrate antigen 125(CA125), pulmonary artery systolic pressure N 60 mm Hg, treatmentwith beta-blockers, furosemide equivalent dose N 120 mg/day and se-verity of PE. Harrell's C-statistics and the Gronnesby and Borgan test(Chi