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Persistent PR segment change in malignant pericardial disease
BACKGROUND: Electrocardiographic changes may manifest in patients with pericardial effusions. PR segment changes are frequently overlooked, but when present, can provide diagnostic significance. The diagnostic value of PR segment changes in determining benign versus malignant pericardial disease in...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837144/ https://www.ncbi.nlm.nih.gov/pubmed/33530138 http://dx.doi.org/10.1186/s40959-016-0015-1 |
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author | Ahluwalia, M. O’Quinn, R. Ky, B. Callans, D. Kucharczuk, J. Carver, J. R. |
author_facet | Ahluwalia, M. O’Quinn, R. Ky, B. Callans, D. Kucharczuk, J. Carver, J. R. |
author_sort | Ahluwalia, M. |
collection | PubMed |
description | BACKGROUND: Electrocardiographic changes may manifest in patients with pericardial effusions. PR segment changes are frequently overlooked, but when present, can provide diagnostic significance. The diagnostic value of PR segment changes in determining benign versus malignant pericardial disease in cancer patients with pericardial effusions has not been investigated. We aimed to determine the relationship between PR segment changes and malignant pericardial disease in cancer patients presenting with pericardial effusions. METHODS: Consecutive patients with active malignancy who underwent surgical subxiphoid pericardial window by a single thoracic surgeon between 2011 and 2014 were included in this study. A total of 104 pre- and post-operative ECGs were reviewed, and PR depression or elevation was defined by deviation of at least 0.5 millivolts from the TP segment using a magnifying glass. Pericardial fluid cytology, flow cytometry and tissue biopsy were evaluated. Baseline characteristics and co-morbidities were compared between cancer patients with benign and malignant pericardial effusions. RESULTS: A total of 26 patients with active malignancy and pericardial effusion who underwent pericardial window over the study period were included. Eighteen (69 %) patients had isoelectric PR segments, of whom none (0 %) had evidence of malignant pericardial disease (100 % negative predictive value). Eight (31 %) patients had significant ECG findings (PR segment depression in leads II, III and/or aVF as well as PR elevation in aVR/V1), all 8 (100 %) of whom had pathologically confirmed malignant pericardial disease (100 % positive predictive value). PR segment changes in all 8 patients persisted (up to 11 months) on post-operative serial ECGs. The PR segment changes had no relationship to heart rate or the time of atrial-ventricular conduction. CONCLUSIONS: In patients with active cancer presenting with pericardial effusion, the presence of PR segment changes is highly predictive of active malignant pericardial disease. When present, PR changes typically persist on serial ECGs even after pericardial window. |
format | Online Article Text |
id | pubmed-7837144 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-78371442021-01-27 Persistent PR segment change in malignant pericardial disease Ahluwalia, M. O’Quinn, R. Ky, B. Callans, D. Kucharczuk, J. Carver, J. R. Cardiooncology Research BACKGROUND: Electrocardiographic changes may manifest in patients with pericardial effusions. PR segment changes are frequently overlooked, but when present, can provide diagnostic significance. The diagnostic value of PR segment changes in determining benign versus malignant pericardial disease in cancer patients with pericardial effusions has not been investigated. We aimed to determine the relationship between PR segment changes and malignant pericardial disease in cancer patients presenting with pericardial effusions. METHODS: Consecutive patients with active malignancy who underwent surgical subxiphoid pericardial window by a single thoracic surgeon between 2011 and 2014 were included in this study. A total of 104 pre- and post-operative ECGs were reviewed, and PR depression or elevation was defined by deviation of at least 0.5 millivolts from the TP segment using a magnifying glass. Pericardial fluid cytology, flow cytometry and tissue biopsy were evaluated. Baseline characteristics and co-morbidities were compared between cancer patients with benign and malignant pericardial effusions. RESULTS: A total of 26 patients with active malignancy and pericardial effusion who underwent pericardial window over the study period were included. Eighteen (69 %) patients had isoelectric PR segments, of whom none (0 %) had evidence of malignant pericardial disease (100 % negative predictive value). Eight (31 %) patients had significant ECG findings (PR segment depression in leads II, III and/or aVF as well as PR elevation in aVR/V1), all 8 (100 %) of whom had pathologically confirmed malignant pericardial disease (100 % positive predictive value). PR segment changes in all 8 patients persisted (up to 11 months) on post-operative serial ECGs. The PR segment changes had no relationship to heart rate or the time of atrial-ventricular conduction. CONCLUSIONS: In patients with active cancer presenting with pericardial effusion, the presence of PR segment changes is highly predictive of active malignant pericardial disease. When present, PR changes typically persist on serial ECGs even after pericardial window. BioMed Central 2016-07-14 /pmc/articles/PMC7837144/ /pubmed/33530138 http://dx.doi.org/10.1186/s40959-016-0015-1 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Ahluwalia, M. O’Quinn, R. Ky, B. Callans, D. Kucharczuk, J. Carver, J. R. Persistent PR segment change in malignant pericardial disease |
title | Persistent PR segment change in malignant pericardial disease |
title_full | Persistent PR segment change in malignant pericardial disease |
title_fullStr | Persistent PR segment change in malignant pericardial disease |
title_full_unstemmed | Persistent PR segment change in malignant pericardial disease |
title_short | Persistent PR segment change in malignant pericardial disease |
title_sort | persistent pr segment change in malignant pericardial disease |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837144/ https://www.ncbi.nlm.nih.gov/pubmed/33530138 http://dx.doi.org/10.1186/s40959-016-0015-1 |
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