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Pericardial involvement during the course of myocardial infarction. A long-term clinical and echocardiographic study
1Department of Medicine II, University Hospital Vinohrady, Charles University, Prague, Czech Republic.
Insights
Pericardial effusion occurs in 43% of myocardial infarctions, typically appearing within 5 days and resolving over weeks to months. Treatments like thrombolysis or anticoagulation do not increase effusion risk.
Area of Science:
- Cardiology
- Internal Medicine
- Echocardiography
Background:
- Pericarditis and pericardial effusion are potential complications following myocardial infarction.
- Understanding their long-term course and clinical impact is crucial for patient management.
Purpose of the Study:
- To investigate the incidence, timing, and resolution of infarct-related pericardial effusion.
- To assess the hemodynamic and clinical consequences of these effusions.
- To evaluate the influence of thrombolytic and anticoagulant therapies on pericardial effusion development.
Main Methods:
- Serial echocardiographic examinations in 192 patients post-myocardial infarction.
- Follow-up conducted during the acute phase and up to 3 years post-infarction.
- Analysis of clinical, angiographic, and autopsy data.
Main Results:
- Pericardial effusion detected in 43% of patients, with most appearing by day 5 and resolving within a year.
- Persistent effusions occurred in 9 patients up to 3 years.
- Infarctions with pericardial involvement were associated with higher rates of heart failure or death (49% vs. 16%).
Conclusions:
- Serial echocardiography reveals pericardial effusion in nearly half of myocardial infarction cases.
- Effusions typically resolve over weeks to months, though some may persist.
- Thrombolytic and anticoagulant therapies do not appear to increase the incidence or size of pericardial effusions.
Study Objective:
This study investigated the long-term course of infarct-related pericarditis and pericardial effusion. Focus was given to the following issues: incidence and timing of pericarditis and pericardial effusion during the acute phase and 3 years follow-up, size, hemodynamic and clinical consequences of effusions, and potential risk of thrombolytic or anticoagulant therapy in patients with pericardial effusion.
Patients And Study Design:
Serial echocardiographic examinations were performed in 192 consecutive patients with first myocardial infarction during the acute phase (day 1, 5, 10, 21) and during 3 years' follow-up (year 1, 2, and 3 after infarction). The follow-up was 100%. Clinical, angiographic, and autopsy data were analyzed.
Results:
Pericardial effusion was detected at least once during serial echocardiographic examinations in 82 of 192 patients (43%). The incidence in different subgroups (with or without thrombolysis, open or closed artery at 3 weeks, infarction in left anterior descending, left circumflex, or right coronary artery perfusion bed) was similar. Most (48%) effusions were first detected on the fifth day, and most (50%) disappeared between days 21 and 365. However, in nine patients, the effusion persisted beyond 1 year (up to 3 years in three patients). Only systolic separation of pericardial layers was detected in 59% of effusions, circular effusion in 3.6% of all effusions. No cardiac tamponade developed. Heart failure or death complicated 49% of infarctions with pericardial involvement and 16% of infarctions without effusion (p < 0.01). Mortality alone was 8% among patients without effusion and 15% among those with more than minimal effusion (not significant).
Conclusions:
Pericardial effusion can be detected by serial echocardiographic examinations in 43% of myocardial infarctions. It appears during the initial 5 days and disappears slowly during several weeks to several months. Anticoagulant and thrombolytic therapy does not increase the frequency or the size of effusions.