E-TAP: A Novel Echocardiographic Risk Stratification Score in the Assessment of Cardiac Tamponade and Decision Making for Pericardiocentesis.

Background

Echocardiographic findings suggesting hemodynamic compromise can precede clinical deterioration in cardiac tamponade. We aim to validate echocardiographic predictors for tamponade and construct a simple imaging-based risk stratification model to guide prompt management plans.

Methods

We retrospectively studied consecutive patients who presented with at least moderate pericardial effusion. Patients with atrial fibrillation, greater than moderate pulmonary hypertension, or mechanical ventilation were excluded. Patients were identified as having cardiac tamponade if the intrapericardial pressure was ≥7 mmHg. The following echocardiographic parameters, each assigned equal weight, were evaluated to create the E-TAP (Echocardiography in Tamponade Assessment to recommend Pericardiocentesis) score: (1) right atrial late diastolic collapse, (2) right ventricular early diastolic collapse, (3) discordant left and right ventricular measurement variation indicating ventricular interdependence, (4) mitral valve inflow E velocity variation >30%, (5) tricuspid valve inflow E velocity variation >60%, (6) left ventricular outflow velocity variation >20%, (7) inferior vena cava plethora, (8) reversal of diastolic flows of the hepatic vein in expiration, and (9) large pericardial effusion.

Results

Of the 254 patients, 134 had tamponade, with a mean E-TAP score of 6.0 +/- 1.8, compared to 3.0 +/-1.7 in those without tamponade (p<0.001). Adjusted logistic regression analyses showed that IVC plethora, TV inflow variation >60%, and LVOT flow variation >20% were independently associated with tamponade. An E-TAP score ≥ 5 best identified patients with tamponade with 80% specificity and 81% sensitivity.

Conclusion

The novel E-TAP score was strongly associated with cardiac tamponade and may facilitate timely decision making for pericardiocentesis.