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

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 600 mg . m - 2 · 24 h - 1; group 2: 30 patients, 46·7% males, mean age 52·5 ± 12·7 years, triamcinolone 300 mg . m - 2 . 24 h - 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 followup, 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 . 24 h - 1 of triamcinolone prevented recurrence of symptoms and relapse of effusion as effectively as the 600 mg . m - 2 . 24 h - 1 regimen, but with significantly fewer side effects. © 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.