Objectives This study sought to investigate the incidence, associated findings, and natural history of effusive-constrictive pericarditis (ECP) after pericardiocentesis.

Background ECP is characterized by the coexistence of tense pericardial effusion and constriction of the heart by the visceral pericardium. Echocardiography is currently the main diagnostic tool in the assessment of pericardial disease, but limited data have been published on the incidence and prognosis of ECP diagnosed by echo-Doppler.

Methods A total of 205 consecutive patients undergoing pericardiocentesis at Mayo Clinic, Rochester, Minnesota, were divided into 2 groups (ECP and non-ECP) based on the presence or absence of post-centesis echocardiographic findings of constrictive pericarditis. Clinical, laboratory, and imaging characteristics were compared.

Results ECP was subsequently diagnosed in 33 patients (16%) after pericardiocentesis. Overt clinical cardiac tamponade was present in 52% of ECP patients and 36% of non-ECP patients (p = 0.08). Post-procedure hemopericardium was more frequent in the ECP group (33% vs. 13%; p = 0.003), and a higher percentage of neutrophils and lower percentage of monocytes were noted on pericardial fluid analysis in those patients. Clinical and laboratory findings were otherwise similar. Baseline early diastolic mitral septal annular velocity was significantly higher in the ECP group. Before pericardiocentesis, respiratory variation of mitral inflow velocity, expiratory diastolic flow reversal of hepatic vein, and respirophasic septal shift were significantly more frequent in the ECP group. Fibrinous or loculated effusions were also more frequently observed in the ECP group. Four deaths occurred in the ECP group; all 4 patients had known malignancies. During median follow-up of 3.8 years (interquartile range: 0.5 to 8.3 years), only 2 patients required pericardiectomy for persistent constrictive features and symptoms.

Conclusions In a large cohort of unselected patients undergoing pericardiocentesis, 16% were found to have ECP. Pre-centesis echocardiographic findings might identify such patients. Long-term prognosis in those patients remains good, and pericardiectomy was rarely required.

目的本研究旨在调查心包穿刺术后流出性缩窄性心包炎（ECP）的发生率，相关发现和自然病史。

背景ECP的特征是紧张性心包积液和内脏心包对心脏的收缩并存。超声心动图是目前评估心包疾病的主要诊断工具，但有关由回声多普勒诊断出的ECP的发生率和预后的数据很少。

方法根据是否存在缩窄性心包炎的穿刺后超声心动图检查结果，将共205例在明尼苏达州罗切斯特市梅奥诊所连续进行心包穿刺的患者分为两组（ECP和非ECP）。比较了临床，实验室和影像学特征。

结果心包穿刺术后，随后有33例（16％）患者被诊断为ECP。52％的ECP患者和36％的非ECP患者存在明显的临床心脏压塞（p = 0.08）。在ECP组中，术后心包膜出血的发生率更高（33％比13％； p = 0.003），并且在这些患者的心包液分析中发现中性粒细胞的百分比较高，而单核细胞的百分比较低。其他方面，临床和实验室检查结果相似。ECP组基线早期舒张二尖瓣中隔间隔环速度明显更高。在心包穿刺术前，ECP组二尖瓣流入速度的呼吸变化，肝静脉呼气舒张逆流和呼吸间隔改变明显更为频繁。在ECP组中，纤维化或局部积液也更常见。ECP组中有4人死亡。所有4例患者均已知恶性肿瘤。在3.8年的中位随访期间（四分位间距：0.5至8.3年），只有2例患者因持续的收缩功能和症状而需要进行心包切除术。

结论在一大批未经选择的接受心包穿刺术的患者中，发现有16％的患者患有ECP。穿刺前超声心动图检查结果可能会识别出此类患者。这些患者的长期预后仍然良好，几乎不需要进行心包切除术。