A Novel Use of Echocardiographic Contrast in Cardiac Tamponade.
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ABSTRACT:
SUBMITTER: Rao A
PROVIDER: S-EPMC9314219 | biostudies-literature | 2022 Jul
REPOSITORIES: biostudies-literature
Publications
A Novel Use of Echocardiographic Contrast in Cardiac Tamponade.
Rao Anila A Rao Lakshmi L Parekh Akarsh A Lala Vasim V Mohan Jay J
Journal of cardiovascular imaging 20220701 3
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Project description:BackgroundTimely and accurate detection of pericardial effusion and assessment cardiac tamponade remain challenging and highly operator dependent.ObjectivesArtificial intelligence has advanced many echocardiographic assessments, and we aimed to develop and validate a deep learning model to automate the assessment of pericardial effusion severity and cardiac tamponade from echocardiogram videos.MethodsWe developed a deep learning model (EchoNet-Pericardium) using temporal-spatial convolutional neural networks to automate pericardial effusion severity grading and tamponade detection from echocardiography videos. The model was trained using a retrospective dataset of 1,427,660 videos from 85,380 echocardiograms at Cedars-Sinai Medical Center (CSMC) to predict PE severity and cardiac tamponade across individual echocardiographic views and an ensemble approach combining predictions from five standard views. External validation was performed on 33,310 videos from 1,806 echocardiograms from Stanford Healthcare (SHC).ResultsIn the held out CSMC test set, EchoNet-Pericardium achieved an AUC of 0.900 (95% CI: 0.884-0.916) for detecting moderate or larger pericardial effusion, 0.942 (95% CI: 0.917-0.964) for large pericardial effusion, and 0.955 (95% CI: 0.939-0.968) for cardiac tamponade. In the SHC external validation cohort, the model achieved AUCs of 0.869 (95% CI: 0.794-0.933) for moderate or larger pericardial effusion, 0.959 (95% CI: 0.945-0.972) for large pericardial effusion, and 0.966 (95% CI: 0.906-0.995) for cardiac tamponade. Subgroup analysis demonstrated consistent performance across ages, sexes, left ventricular ejection fraction, and atrial fibrillation statuses.ConclusionsOur deep learning-based framework accurately grades pericardial effusion severity and detects cardiac tamponade from echocardiograms, demonstrating consistent performance and generalizability across different cohorts. This automated tool has the potential to enhance clinical decision-making by reducing operator dependence and expediting diagnosis.
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| S-EPMC6058926 | biostudies-literature
Project description:We present a previously healthy young man with cardiac tamponade. He underwent emergency pericardiocentesis. The pericardial fluid was exudative, and Salmonella sp. was grown on both pericardial and blood cultures. Further investigations revealed that this patient had classical Hodgkin lymphoma, which explains his immunocompromised state predisposing him to this infection. (Level of Difficulty: Advanced.).
| S-EPMC9666747 | biostudies-literature
Project description:Cardiac tamponade is a rare and life-threatening condition that can be caused by trauma and various medical conditions. Failure to recognize and repair it quickly could lead to significant morbidity or even death. This case demonstrates the electrocardiogram (ECG) findings of low voltage QRS and electrical alternans in cardiac tamponade. It also highlights the classic ultrasound (US) findings of pericardial effusion and right ventricular collapse during diastole in cardiac tamponade. Classic physical exam findings of cardiac tamponade include Beck's Triad (jugular venous distention, hypotension, and muffled heart sounds) and pulsus paradoxus. This patient only had jugular venous distention and pulsus paradoxus. The case is centered on a 52-year-old male who presented with shortness of breath, wheezing, and a productive cough with streaks of blood. A CT chest was performed which revealed a large pericardial effusion, right upper lobe lung mass, and bilateral pulmonary emboli. A bedside transthoracic echocardiogram was then performed which confirmed the large effusion as well as right ventricular collapse during diastole. Cardiothoracic surgery and interventional cardiology were consulted and both agreed to take the patient to the cardiac catheterization lab for percutaneous drainage of the effusion. Pericardiocentesis was performed and 1.7 liters of serosanguinous fluid was removed and a drain was left in place. He recovered well from the procedure and had an uneventful admission. After reviewing this case, learners should be able to recognize the diagnostic features and various causes of pericardial effusion and cardiac tamponade.TopicsElectrocardiography, echocardiography, cardiac tamponade.
| S-EPMC10332784 | biostudies-literature
Project description:ContextCardiac tamponade (CT) following cardiac surgery is a potentially fatal complication and the cause of surgical reintervention in 0.1%-6% of cases. There are two types of CT: acute, occurring within the first 48 h postoperatively, and subacute or delayed, which occurs more than 48 h postoperatively. The latter does not show specific clinical signs, which makes it more difficult to diagnose. The factors associated with acute CT (aCT) are related to coagulopathy or surgical bleeding, while the variables associated with subacute tamponade have not been well defined.AimsThe primary objective of this study was to identify the factors associated with the development of subacute CT (sCT).Settings and designThis report describes a case (n = 80) and control (n = 160) study nested in a historic cohort made up of adult patients who underwent any type of urgent or elective cardiac surgery in a tertiary cardiovascular hospital. Methods: The occurrence of sCT was defined as the presence of a compatible clinical picture, pericardial effusion and confirmation of cardiac tamponade during the required emergency intervention at any point between 48 hours and 30 days after surgery. All factors potentially related to the development of sCT were taken into account.Statistical analysis usedFor the adjusted analysis, a logistical regression was constructed with 55 variables, including pre-, intra-, and post-operative data.ResultsThe mortality of patients with sCT was 11% versus 0% in the controls. Five variables were identified as independently and significantly associated with the outcome: pre- or post-operative anticoagulation, reintervention in the first 48 h, surgery other than coronary artery bypass graft, and red blood cell transfusion.ConclusionsOur study identified five variables associated with sCT and established that this complication has a high mortality rate. These findings may allow the implementation of standardized follow-up measures for patients identified as higher risk, leading to either early detection or prevention.
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Project description:Rivaroxaban is a direct oral anticoagulant (DOAC) approved as an important alternative to warfarin in patients with nonvalvular atrial fibrillation. We report the case of an 87-year-old man with past medical history of nonvalvular atrial fibrillation on rivaroxaban and recently started amiodarone for pulseless ventricular tachycardia who presented to our hospital with intermittent chest pain and was diagnosed with spontaneous hemopericardium causing cardiac tamponade. The culprit drugs were discontinued, and the patient was treated with emergent pericardiocentesis. Both rivaroxaban and amiodarone are substrates for the CYP3A4 hepatic pathway, and concomitant use can result in increased plasma rivaroxaban levels causing an increased propensity to bleeding. While most physicians are cognizant of the need for renal dosing of rivaroxaban, this article aims to increase awareness of its interactions with drugs that are also metabolized through the same hepatic CYP450 pathway.
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