Pulmonary hypertension in cardiac tamponade: An observational cohort study of in-hospital mortality and echocardiographic findings

Document Type

Article

Publication Date

4-1-2026

Publication Title

The American journal of emergency medicine

Keywords

Humans, Cardiac Tamponade, Male, Female, Hospital Mortality, Retrospective Studies, Echocardiography, Middle Aged, Hypertension, Pulmonary, Aged, Pericardial Effusion, Drainage

Abstract

BACKGROUND: Patients with pulmonary hypertension (PHTN) (i.e., chronic PHTN) have right ventricular hypertrophy, elevated right-sided heart pressures, and frequently have pericardial effusions. When evaluating these patients for cardiac tamponade, the hypertrophy and elevated pressure in right heart may be protective from tamponade by counteracting the pressure from the pericardial effusion. However, these patients may be harmed if echocardiographic signs of tamponade (e.g., right ventricular diastolic collapse) are obscured.

STUDY OBJECTIVE: The effect of PHTN on patients with cardiac tamponade remains unclear. We aimed (1) to evaluate whether PHTN influences the echocardiographic findings of tamponade, and (2) to examine whether PHTN is associated with in-hospital mortality among patients undergoing pericardial drainage primarily for cardiac tamponade.

METHODS: We conducted a retrospective observational study of adult patients who underwent pericardial drainage within 48 h of emergency department presentation at two academic centers. PHTN probability was classified using the 2022 European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines. We classified patients in four categories: no PHTN, low probability, intermediate probability, and high probability of PHTN. PHTN parameters were manually extracted from cardiologist-interpreted echocardiography reports. The primary outcome was in-hospital mortality. Secondary outcomes included the prevalence of echocardiographic findings of cardiac tamponade and their associations with mortality.

RESULTS: A total of 249 patients met the inclusion criteria. In-hospital mortality did not significantly differ across PHTN probability categories: no PHTN (63.8%), low probability (9.3%), intermediate probability (20.9%), and high probability (5.3%) (p-values all >0.2). Among patients who died, 50.0% were in the no PHTN group compared to 7.1% in the high probability group (p = 0.222). The echocardiographic impression of cardiac tamponade was significantly lower among patients with high PHTN probability compared to those with no PHTN (64.3% vs. 85.4%, p = 0.041), with a weak negative correlation (r = -0.493) between increasing PHTN probability and tamponade impression.

CONCLUSIONS: In this cohort of patients undergoing pericardial drainage primarily for cardiac tamponade, PHTN was not significantly associated with in-hospital mortality. However, patients with a high probability of PHTN showed fewer echocardiographic signs of tamponade, suggesting that PHTN may obscure typical sonographic findings of tamponade.

Medical Subject Headings

Humans; Cardiac Tamponade; Male; Female; Hospital Mortality; Retrospective Studies; Echocardiography; Middle Aged; Hypertension, Pulmonary; Aged; Pericardial Effusion; Drainage

PubMed ID

41570494

Volume

102

First Page

55

Last Page

61

Find It @ Sladen

Share

COinS