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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Incidence, risk factors and clinical outcomes of pericardial effusion in left ventricular assist device patients
Muhammad Zubair Khan, Yevgeniy Brailovsky, Mohammad Alfrad Nobel Bhuiyan, Gregary Marhefka, Abu S M Faisal, Adrija Sircar, Parker O'Neill, J Eduardo Rame, Sona Franklin, Muhammad Waqas, Hadia Shah, Indranee Rajapreyar, Rene J Alvarez
Muhammad Zubair Khan, Gregary Marhefka, Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, United States
Yevgeniy Brailovsky, Department of Cardiology, Sidney Kimmel School of Medicine, Jefferson Heart Institute, Thomas Jefferson University, Philadelphia, PA 19107, United States
Mohammad Alfrad Nobel Bhuiyan, Abu S M Faisal, Department of Internal Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, United States
Adrija Sircar, Parker O'Neill, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA 19107, United States
J Eduardo Rame, Indranee Rajapreyar, Rene J Alvarez, Department of Cardiology, Thomas Jefferson University, Philadelphia, PA 19107, United States
Sona Franklin, Department of Medicine, Jefferson Abington Hospital, Abington, PA 19001, United States
Muhammad Waqas, Hadia Shah, Department of Medicine and Surgery, Saidu Medical College Swat, Khyber Pakhtunkhwa, Pakistan
Author contributions: Franklin S, Shah H were involved in the graphical abstract; Khan MZ, Brailovsky Y, Alvarez RJ contributed to the conceptualization of this manuscript; Khan MZ, Sircar A, O'Neill P, Waqas M, Brailovsky Y participated in the writing and review; Marhefka G, Alvarez RJ, Rajapreyar I, Rame JE contributed to the review and supervision of this manuscript; Franklin S, Shah H and Waqas M participated to make graphs and tables; Bhuiyan MAN and Faisal ASM did stastictics; all authors have read and approved the final manuscript.
Institutional review board statement: This study, entitled, “Incidence, Risk Factors and Clinical Outcomes of Pericardial Effusion in LVAD Patients,” was considered exempt from the formal approval of the Institutional Review Board, as the study cohort was derived from a publicly available database containing non-identifiable patient information.
Informed consent statement: Our study meets the definition of Not Human Subject Research, as our study utilized de-identified data obtained from the National Inpatient Sample database between the years 2016 and 2018. We had no access to direct patient identifiers or identifiable information. Prior to obtaining the data from the NIS database utilized in our study, the data had already been de-identified. No data in our study can be used to identify any patients.
Conflict-of-interest statement: There are no conflicts of interest.
Data sharing statement: Data was de-identified. No additional data available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Muhammad Zubair Khan, MD, Department of Cardiology, Thomas Jefferson University Hospital, 111 S 11th St, Philadelphia, PA 19107, United States.
muhammad.khan2@jefferson.edu
Received: January 21, 2025
Revised: April 16, 2025
Accepted: June 3, 2025
Published online: June 26, 2025
Processing time: 151 Days and 2.6 Hours
BACKGROUND
Development of pericardial effusion in patients with left ventricular assist devices (LVADs) can be detrimental to health outcomes. This study aims to elucidate the prevalence and risk factors for pericardial effusion in patients with LVADs.
AIM
To elucidate risk factors associated with the presence of pericardial effusion in patients with LVADs and compare the clinical outcomes of those with and without pericardial effusion. The secondary goal is to determine the incidence of pericardiocentesis and pericardial window placement in patients with LVADs experiencing pericardial effusion.
METHODS
Data were obtained from the National Inpatient Sample database between 2016 and 2018. Statistical analysis was performed using Pearson χ2 test and multivariate logistic regression analysis to determine clinical outcomes of pericardial effusion and to identify variables associated with pericardial effusion in LVAD patients, respectively.
RESULTS
The prevalence of LVAD was 9850 (0.01%) among total study patients (n = 98112095). The incidence of pericardial effusion among LVAD patients was 640 (6.5%). The prevalence of liver disease (26.6% vs 17.4%), chronic kidney disease (CKD; 54.6% vs 49.4%), hypothyroidism (21.9% vs 18.1%), congestive heart failure (98.4% vs 96.5%), atrial fibrillation (Afib; 58.59% vs 50.5%), coronary artery disease (CAD; 11.7% vs 4.4%), dyslipidemia (31.3% vs 39.3%), and having undergone percutaneous coronary intervention (PCI; 1.6% vs 0.7%) was higher in the pericardial effusion cohort vs the non-pericardial effusion cohort. Multivariate regression analysis demonstrated that CAD (OR = 2.89) and PCI (OR = 2.2) had the greatest association with pericardial effusion in patients with LVADs. These were followed by liver disease (OR = 1.72), hypothyroidism (OR = 1.2), electrolyte derangement (OR = 1.2), Afib (OR = 1.1), and CKD (OR = 1.05). Among patients with LVADs, the median length of stay (33 days vs 27 days) and hospitalization cost (847525 USD vs 792616 USD) were significantly higher in the pericardial effusion cohort compared to the non-pericardial effusion cohort. There was no significant difference in mortality between cohorts. The prevalence of cardiac tamponade was 109 (17.9% of LVAD patients with pericardial effusion). Ten (9.2% of LVAD patients with cardiac tamponade) patients underwent pericardiocentesis and 44 (40.3%) received a pericardial window.
CONCLUSION
This study shows that liver disease, CKD, PCI, hypothyroidism, electrolyte derangement, Afib, and CAD had a significant association with pericardial effusion in LVAD patients. Hospitalization cost and length of stay were higher in the pericardial effusion group, but mortality was the same.
Core Tip: Pericardial effusions in patients with left ventricular assist devices (LVADs) can lead to prolonged hospitalization and increased healthcare costs. Risk factors associated with the development of pericardial effusions include: Liver disease, chronic kidney disease (CAD), hypothyroidism, electrolyte derangement, atrial fibrillation, with the highest association found with CAD and percutaneous coronary intervention. While the presence of pericardial effusions did not have significant impact on mortality in our study, further studies are needed to elucidate whether the optimization of these co-morbidities would reduce the incidence of pericardial effusion in patients with LVADs.
