Intrapericardial treatment of autoreactive pericardial effusion with triamcinolone - The way to avoid side effects of systemic corticosteroid therapy

被引:111
作者
Maisch, B [1 ]
Ristic, AD [1 ]
Pankuweit, S [1 ]
机构
[1] Univ Marburg, Dept Internal Med Cardiol, D-35033 Marburg, Germany
关键词
pericarditis; pericardium; pericardiocentesis; triamcinolone;
D O I
10.1053/euhj.2002.3152
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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-AF 1101B1), 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 600 mg . m(-2) . 24h(-1) ; group 2: 30 patients, 46.7% males, mean age 52.5 +/- 12.7 years, triamcinolone 300 mg . 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 300 mg . m(-2) . 24h(-1) of triamcinolone prevented recurrence of symptoms and relapse of effusion as effectively as the 600 mg . m(-2) . 24h(-1) regimen, but with significantly fewer side effects. (C) 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.
引用
收藏
页码:1503 / 1508
页数:6
相关论文
共 20 条
[1]   Colchicine treatment for recurrent pericarditis - A decade of experience [J].
Adler, Y ;
Finkelstein, Y ;
Guindo, J ;
de la Serna, AR ;
Shoenfeld, Y ;
Bayes-Genis, A ;
Sagie, A ;
de Luna, AB ;
Spodick, DH .
CIRCULATION, 1998, 97 (21) :2183-2185
[2]   Disseminated varicella and staphylococcal pericarditis after topical steroids [J].
Brumund, MR ;
Truemper, EJ ;
Lutin, WA ;
PearsonShaver, AL .
JOURNAL OF PEDIATRICS, 1997, 131 (01) :162-163
[3]   TREATMENT OF INTRACTABLE UREMIC PERICARDIAL-EFFUSION - AVOIDANCE OF PERICARDIECTOMY WITH LOCAL STEROID INSTILLATION [J].
BUSELMEIER, TJ ;
DAVIN, TD ;
SIMMONS, RL ;
NAJARIAN, JS ;
KJELLSTRAND, CM .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1978, 240 (13) :1358-1359
[4]   SUBXIPHOID PERICARDIOSTOMY FOR HEMODIALYSIS-ASSOCIATED PERICARDIAL-EFFUSION [J].
DAUGIRDAS, JT ;
LEEHEY, DJ ;
POPLI, S ;
MCCRAY, GM ;
GANDHI, VC ;
PIFARRE, R ;
ING, TS .
ARCHIVES OF INTERNAL MEDICINE, 1986, 146 (06) :1113-1115
[5]  
FEINROTH MV, 1981, CLIN NEPHROL, V15, P331
[6]   REVERSAL OF INTRACTABLE UREMIC PERICARDITIS BY TRIAMCINOLONE HEXACETONIDE [J].
FULLER, TJ ;
KNOCHEL, JP ;
BRENNAN, JP ;
FETNER, CD ;
WHITE, MG .
ARCHIVES OF INTERNAL MEDICINE, 1976, 136 (09) :979-982
[7]   IATROGENIC CUSHINGS-SYNDROME AFTER INTRA-PERICARDIAL CORTICOSTEROID-THERAPY [J].
GRUBB, SR ;
CANTLEY, LK ;
JONES, DL ;
CARTER, WH .
ANNALS OF INTERNAL MEDICINE, 1981, 95 (06) :706-707
[8]  
KRISTAL B, 1986, ISRAEL J MED SCI, V22, P442
[9]   Intrapericardial treatment of autoreactive myocarditis with triamcinolon - Successful administration in patients with minimal pericardial effusion [J].
Maisch, B ;
Ristic, AD ;
Seferovic, PM ;
Spodick, DH .
HERZ, 2000, 25 (08) :781-786
[10]  
Maisch B, 1999, CLIN CARDIOL, V22, pI17