A novel ECG based tool for diagnosing pericardial effusion: A case-control study

Current electrocardiographic (ECG) criteria for diagnosing pericardial effusion are limited by low sensitivity. This study aimed to evaluate traditional ECG criteria within a contemporary patient cohort and to compare the diagnostic accuracy of a novel ECG-based score, the ARENA score, with conventional low-voltage criteria for the detection of pericardial effusion.

A retrospective case-control study was conducted at a university hospital, including consecutive patients who underwent both echocardiography and ECG, regardless of admission diagnosis. Patients were divided into derivation and validation cohorts, each comprising individuals with and without pericardial effusion (≥1.0 cm). ECGs were analyzed using traditional low-voltage criteria and the ARENA score, with sensitivity, specificity, accuracy and likelihood ratios calculated for both.

A total of 244 patients were included, with 104 presenting with pericardial effusion and 140 without. These patients were divided into a derivation cohort (n = 100) and a validation cohort (n = 144). In the validation cohort, sensitivity was 5.6 % (95 % CI: 0.0 %-11.7 %) with traditional criteria and 51.9 % (95 % CI: 38.5 %-65.3 %) with the ARENA score (p < 0.001). Specificity was 92.2 % (95 % CI: 86.7 %-97.8 %) for traditional criteria and 82.2 % (95 % CI: 74.3 %-90.1 %) for the ARENA score (p = 0.047). Accuracy in the validation cohort was 59.7 % (95 % CI: 51.7 %-67.7 %) for traditional criteria and 70.8 % (95 % CI: 63.4 %-78.2 %) for the ARENA score (p = 0.048).

The ARENA score demonstrates higher sensitivity and accuracy in detecting pericardial effusion compared to traditional low-voltage ECG criteria, though with a modest reduction in specificity.