Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography · 2026
Quantitation of Pericardial Fluid Volume: Volumetric Estimation Compared with Guideline-Based Linear Grading.
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Kane Aidan R, Luis Sushil Allen, Geske Jeffrey B, Thaden Jeremy J, Nkomo Vuyisile T, Kane Garvan C, Bird Jared G, Sinak Lawrence J, Pislaru Sorin V
Аннотация
AIMS: The aim of this study was to compare guideline-based linear and two-dimensional echocardiographic measures against drained pericardial fluid volume in patients undergoing pericardiocentesis and determine whether volumetric quantification improves accuracy and categorical grading of pericardial effusion size.
METHODS AND RESULTS: We retrospectively studied 245 adults who underwent transthoracic echocardiography immediately before complete pericardiocentesis. Blinded measurements included (1) maximal end-diastolic effusion thickness, (2) parasternal long-axis and (3) short-axis effusion area (pericardial silhouette minus cardiac silhouette), and (4) apical 4-chamber Simpson's volumetric estimation of pericardial space volume (pericardial minus epicardial tracings). Complete drained fluid volume served as the reference standard. Median drained volume was 500 mL (range, 50-4,300), and 76.7% had tamponade. Linear thickness correlated modestly with drained volume (R2 = 0.484; root mean squared error [RMSE] 353 mL). Parasternal area-based methods performed similarly (R2 = 0.53-0.58; RMSE, 318-334 mL). In contrast, Simpson's apical 4-chamber volumetric estimation showed stronger agreement (R2 = 0.88; RMSE = 172 mL; concordance correlation coefficient, 0.94) with minimal bias (mean bias, -14 mL; 95% limits of agreement, -373 to 344 mL). Volumetric categorization improved agreement versus linear grading (κ 0.695 vs 0.293) and increased overall accuracy (80.4% vs 49.4%).
CONCLUSIONS: Guideline-suggested linear grading of pericardial effusion size demonstrates substantial imprecision. A simple apical 4-chamber Simpson's volumetric approach is more accurate and provides better categorical classification, supporting its use to enhance communication and serial follow-up.
METHODS AND RESULTS: We retrospectively studied 245 adults who underwent transthoracic echocardiography immediately before complete pericardiocentesis. Blinded measurements included (1) maximal end-diastolic effusion thickness, (2) parasternal long-axis and (3) short-axis effusion area (pericardial silhouette minus cardiac silhouette), and (4) apical 4-chamber Simpson's volumetric estimation of pericardial space volume (pericardial minus epicardial tracings). Complete drained fluid volume served as the reference standard. Median drained volume was 500 mL (range, 50-4,300), and 76.7% had tamponade. Linear thickness correlated modestly with drained volume (R2 = 0.484; root mean squared error [RMSE] 353 mL). Parasternal area-based methods performed similarly (R2 = 0.53-0.58; RMSE, 318-334 mL). In contrast, Simpson's apical 4-chamber volumetric estimation showed stronger agreement (R2 = 0.88; RMSE = 172 mL; concordance correlation coefficient, 0.94) with minimal bias (mean bias, -14 mL; 95% limits of agreement, -373 to 344 mL). Volumetric categorization improved agreement versus linear grading (κ 0.695 vs 0.293) and increased overall accuracy (80.4% vs 49.4%).
CONCLUSIONS: Guideline-suggested linear grading of pericardial effusion size demonstrates substantial imprecision. A simple apical 4-chamber Simpson's volumetric approach is more accurate and provides better categorical classification, supporting its use to enhance communication and serial follow-up.