Incidence, risk factors and clinical outcomes of pericardial effusion in left ventricular assist device patients.

Abstract

Background: Development of pericardial effusion in patients with left ventricular assist devices (LVADs) can be detrimental to health outcomes. This study aims to elucidate the prevalence and risk factors for pericardial effusion in patients with LVADs.

Aim: To elucidate risk factors associated with the presence of pericardial effusion in patients with LVADs and compare the clinical outcomes of those with and without pericardial effusion. The secondary goal is to determine the incidence of pericardiocentesis and pericardial window placement in patients with LVADs experiencing pericardial effusion.

Methods: Data were obtained from the National Inpatient Sample database between 2016 and 2018. Statistical analysis was performed using Pearson χ ² test and multivariate logistic regression analysis to determine clinical outcomes of pericardial effusion and to identify variables associated with pericardial effusion in LVAD patients, respectively.

Results: The prevalence of LVAD was 9850 (0.01%) among total study patients (n = 98112095). The incidence of pericardial effusion among LVAD patients was 640 (6.5%). The prevalence of liver disease (26.6% vs 17.4%), chronic kidney disease (CKD; 54.6% vs 49.4%), hypothyroidism (21.9% vs 18.1%), congestive heart failure (98.4% vs 96.5%), atrial fibrillation (Afib; 58.59% vs 50.5%), coronary artery disease (CAD; 11.7% vs 4.4%), dyslipidemia (31.3% vs 39.3%), and having undergone percutaneous coronary intervention (PCI; 1.6% vs 0.7%) was higher in the pericardial effusion cohort vs the non-pericardial effusion cohort. Multivariate regression analysis demonstrated that CAD (OR = 2.89) and PCI (OR = 2.2) had the greatest association with pericardial effusion in patients with LVADs. These were followed by liver disease (OR = 1.72), hypothyroidism (OR = 1.2), electrolyte derangement (OR = 1.2), Afib (OR = 1.1), and CKD (OR = 1.05). Among patients with LVADs, the median length of stay (33 days vs 27 days) and hospitalization cost (847525 USD vs 792616 USD) were significantly higher in the pericardial effusion cohort compared to the non-pericardial effusion cohort. There was no significant difference in mortality between cohorts. The prevalence of cardiac tamponade was 109 (17.9% of LVAD patients with pericardial effusion). Ten (9.2% of LVAD patients with cardiac tamponade) patients underwent pericardiocentesis and 44 (40.3%) received a pericardial window.

Conclusion: This study shows that liver disease, CKD, PCI, hypothyroidism, electrolyte derangement, Afib, and CAD had a significant association with pericardial effusion in LVAD patients. Hospitalization cost and length of stay were higher in the pericardial effusion group, but mortality was the same.