In ambulatory patients with pulmonary hypertension (PH), systemic venous hypertension is associated with the presence of pericardial effusions, whereas pulmonary venous hypertension is linked to the development of pleural effusion. These were among the findings of an analysis published in The American Journal of the Medical Sciences.

Researchers conducted a cross-sectional study using point-of-care ultrasonography (POCUS) to identify the link between pulmonary hemodynamic variables and the presence of pericardial and pleural effusion. The study enrolled 32 patients who in the same day underwent right heart catheterization (RHC) for the assessment of PH and POCUS to establish the presence of pericardial and pleural effusion.

Following the RHC, 78% (25 of 32) of the patients met clinical criteria for a PH diagnosis, which was defined as a mean pulmonary artery pressure (mPAP) of at least 25 mm Hg. The majority of the participants (68%; 17 of 25) were classified as World Health Organization (WHO) Group I PH, of whom 7 had systemic sclerosis, 6 had idiopathic PH, 1 had mixed connective tissue disease, 1 had Sjögren’s syndrome, 1 had dasatinib toxicity, and 1 had toluene toxicity. In the study cohort, hemodynamic data demonstrated a mean right atrial pressure (RAP) of 10.0 mm Hg, a mean mPAP of 40.6 mm Hg, and a mean pulmonary artery wedge pressure (PAWP) of 12.7 mm Hg.


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Overall, 24% (6 of 25) of the patients with PH had pleural effusions, of whom 67% (4 of 6) of them had a PAWP of more than 15 mm Hg. Further, 44% (11 of 25) of the patients with PH also had pericardial effusions, with 91% (10 of 11) of these individuals having an elevated RAP of more than 10 mm Hg.

A significant association was reported between the presence of a pleural effusion and a PAWP of more than 15 mm Hg (P =.032), as well as between the presence of a pericardial effusion and an RAP of more than 10 mm Hg (P =.004). No statistically significant association was noted, however, between an RAP of more than 10 mm Hg and pleural effusion (P =.180), nor between an elevated PAWP and pericardial effusions (P =.075).

POCUS had a low positive predictive value of 67% for detection of a pleural effusion. The presence of a pericardial effusion, however, was highly predictive of the presence of systemic venous hypertension, with a positive predictive value of 91%.

The investigators concluded that based on the findings from this study, a prospective, longitudinal study is warranted to confirm these results in both decompensated and compensated patients with RHF.

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Chopra A, Highland KB, Kilb E, Huggins JT.  The relationship of pleural and pericardial effusion with pulmonary hemodynamics in patients with pulmonary hypertension.Am J Med Sci. 2021;361(6):731-735. doi:10.1016/j.amjms.2021.01.003