Copyright © 2002 by the European Society of Cardiology.
Intrapericardial treatment of autoreactive pericardial effusion with triamcinolone. The way to avoid side effects of systemic corticosteroid therapy
Department of Internal Medicine-Cardiology, Philipps University, Marburg, Germany
revised December 3, 2001; accepted December 4, 2001
Abstract
Aims To evaluate efficacy and safety of intrapericardial treatment with the crystalloid corticosteroid triamcinolone in autoreactive pericardial effusion.
Methods and Results Two hundred and sixty consecutive patients with pericarditis/myopericarditis underwent pericardiocentesis, pericardioscopy (Storz-AF1101B1), and epicardial biopsy with pericardial fluid and tissue analyses. By polymerase chain reaction for cardiotropic viruses/bacteria in pericardial effusion and epicardial biopsies as well as by immunohistochemistry and immunocytochemistry of epicardial and endomyocardial biopsies, 84/260 patients were classified as autoreactive pericarditis and underwent intrapericardial instillation of triamcinolone (group 1: 54 patients, 50% males, mean age 48·9±14·3 years, triamcinolone 600mg.m–2.24h–1; group 2: 30 patients, 46·7% males, mean age 52·5±12·7 years, triamcinolone 300mg.m–2.24h–1). Intrapericardial administration of triamcinolone resulted in symptomatic improvement and prevented effusion recurrence in 92·6% vs 86·7% of the patients after 3 months and in 86·0% vs 82·1% after 1 year in groups 1 and 2, respectively (P>0·05). There were no treatment-related acute complications. During the follow-up, 29·6% of the patients developed transitory iatrogenic Cushing syndrome in group 1 in contrast to 13·3% in group 2 (P<0·05).
Conclusion Intrapericardial treatment of autoreactive pericarditis with 300mg.m–2.24h–1 of triamcinolone prevented recurrence of symptoms and relapse of effusion as effectively as the 600mg.m–2.24h–1 regimen, but with significantly fewer side effects. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.
Key Words: Pericarditis, pericardium, pericardiocentesis, triamcinolone
f1 Correspondence: Prof Dr Bernhard Maisch, FESC, FACC, Director, Department of Internal Medicine-Cardiology, Philipps University Marburg, Baldingerstrasse 1, 35033 Marburg, Germany.
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