Pericardial effusion in the elderly: a different disease?

Introduction and aim of the study. The aim of the present study was to asse ss possible differences in etiologic spectrum and clinical course of perica rdial effusion in elderly patients, as has been previously suggested, and t herefore determine whether clinical, management should be based on patient age. Methods. All echocardiograms performed in our hospital from 1990 to 1996 we re screened for pericardial effusion, and those with moderate or large effu sions were selected. Patients under 66 years of age were included in group I, and those above 65 years were assigned to group II. Results. We selected 322 patients with moderate (122) or with large (200) e ffusions. 221 patients being included in group I (aged 15-65, mean 47) End 101 in group II (aged 66-88, mean 72.5). Effusion was large in 60% of group I and in 66% of group II (p = NS), and tamponade occurred in 36% and 38.6% , respectively (p = NS). Specific pericardial infections (tuberculous and p urulent pericarditis) were more frequent in group I (5.9 versus 0.9%; p < 0 .05). No significant differences were found in incidence of idiopathic (33 vs 38%) or neoplastic (14.4 vs 10.8%) etiologies. During follow-up (96% of the patients, median time of 11 months, range 1-58 months) the mortality (2 4 vs 30%) and evolution to cardiac constriction (4 vs 2%) were similar in t he two groups, but persistence of effusion was more common in group II (6.3 vs 14%; p < 0.05). Conclusions. Our study suggests that etiology, clinical course and prognosi s of moderate and large pericardia[ effusion are, in general, similar in el derly and younger patients. Thus, management should be similar in the diffe rent age groups, and no etiologic form of pericardial disease should be rul ed out because of patient's age when considering the differential diagnosis .