Cardiac tamponade, the accumulation of fluid around the heart, affects nearly 6 percent of lupus patients in India, a new retrospective study shows.
But researchers found new risk factors that predict this condition, which may help identify patients at risk. Treatment with high-dose immunosuppressives reduced the risk for fluid reaccumulation and the need for surgery in these patients, the team reported.
The study, “Cardiac tamponade in systemic lupus erythematosus,” was published in QJM: An International Journal of Medicine. It was conducted by researchers at the Institute of Post Graduate Medical Education and Research in Kolkata (IPGMER), in India.
Lupus is an autoimmune disease that affects several organs, including the heart. Pericarditis, an inflammation of the layers surrounding the heart, is the most common heart manifestation of the disease, affecting 9% to 54% of lupus patients. While it has a lower incidence (less than 2.5%), cardiac tamponade may also manifest.
Cardiac tamponade is characterized by the accumulation of fluids in the space between the heart and its protective membranes, leading to heart compression and low pumping capacity. But despite its severity, little is known about cardiac tamponade in lupus patients.
In a study led by Rudra Goswami, a post-doctoral trainee in the Department of Rheumatology at IPGMER, researchers evaluated the incidence of cardiac tamponade, its clinical features, potential risk factors, and treatments in a cohort of Indian lupus patients.
The study included 409 lupus patients. Among them, 25.4 percent had pericarditis and 5.9 percent had cardiac tamponade.
Patients with tamponade were older and had later lupus onset, compared to the remaining lupus patients. All 24 patients with cardiac tamponade experienced shortness of breath; 12 had increased jugular venous pressure; 11 had chest pain; and eight had low blood pressure.
All patients with cardiac tamponade had accumulations of liquid around the heart (pericardial effusion), 14 with large effusion, seven with moderate effusion, and three with small effusions.
They showed higher prevalence of pleuritis, which is an inflammation of the membrane surrounding the lungs, inflammation of the pancreas, and were more prone to present anti-nucleosome antibodies, a biomarker of lupus.
Additional analyses confirmed that pleuritis, anti-nucleosome antibodies, and the size of effusion were all predictive of cardiac tamponade in lupus patients.
All patients underwent aspiration to remove the accumulated liquid. Three patients required more than one aspiration due to re-accumulation of liquids, and only one required surgical treatment. The majority of patients received corticosteroids and immunosuppressive drugs, which were found to be effective in preventing progression of cardiac symptoms and reducing the need for surgery.
“We made a few important observations, such as the importance of concomitant pleuritis and anti-nucleosome antibody positivity in addition to size of pericardial effusion as predictors of tamponade,” the researchers wrote.
“We also feel that immunosuppression with methylprednisolone and IV cyclophosphamide are essential, especially to reduce risk of reaccumulation and surgery,” they added.