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CLINICAL STUDY

clinical correlates of pr-segment depression in asymptomatic patients with pericardial effusion

Yoshihiro Kudo, MD^*,*, Fumiyasu Yamasaki, MD^*, Yoshinori Doi, MD and Tetsuro Sugiura, MD^*

^* Clinical Laboratory MedicineKochi, Japan
Department ofGeriatric Medicine, Kochi Medical School, Kochi, Japan

Manuscript received November 6, 2001; revised manuscript received March 5, 2002, accepted March 27, 2002.

^* Reprint requests and correspondence: Dr. Yoshihiro Kudo, Department of Clinical Laboratory Medicine, Kochi Medical School, Kohasu Oko-cho Nankoku City, Kochi, Japan 783-8505.
kudohy{at}med.kochi-ms.ac.jp

OBJECTIVES: The purpose of this study was to determine the clinical correlates of PR-segment depression among consecutive asymptomatic patients with pericardial effusion (PE) detected by routine echocardiography.

BACKGROUND: Pericardial effusion is a relatively common finding in clinical practice, but not many studies have evaluated electrocardiographic (ECG) changes associated with the occurrence of PE.

METHODS: Among 4,061 consecutive patients referred to our echocardiography laboratory, 176 asymptomatic patients had PE correlated with their clinical history and ECG findings.

RESULTS: PR-segment depression was detected in 40 patients (23%). There were no significant differences in age, gender distribution or heart rate between patients with and without PR-segment depression. Fifteen post-pericardiotomy patients (33%), 19 patients (40%) with malignant disease and 6 patients (46%) with connective tissue disease had PR-segment depression, whereas no patient with heart disease (dilated cardiomyopathy, hypertensive heart disease, old myocardial infarction, valvular heart disease), renal disease or hypothyroidism had PR-segment depression, nor widespread ST-segment elevation. Among 40 patients with PR-segment depression, 8 had ST-segment elevation in the leads of epicardial derivation, 8 had upright T waves, 20 had low to inverted T waves with an isoelectric ST-segment and 4 had ST-T–wave changes due to bundle branch block.

CONCLUSIONS: PR-segment depression was a relatively common ECG sign associated with clinically silent PE, and it was an ECG indicator of inflammatory pericardial involvement.

Abbreviations and Acronyms   ECG = electrocardiogram/electrocardiographic   LV = left ventricular   MI = myocardial infarction   PE = pericardial effusion

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