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Clinical Investigations: CARDIOLOGY |

Clinical Significance of Low Voltage in Asymptomatic Patients With Pericardial Effusion Free of Heart Disease*

Yoshihiro Kudo; Fumiyasu Yamasaki; Tadafumi Doi; Yoshinori Doi; Tetsuro Sugiura
Author and Funding Information

*From the Departments of Clinical Laboratory Medicine (Drs. Kudo, Yamasaki, Sugiura, and Mr. Doi) and of Geriatric Medicine (Dr. Doi), Kochi Medical School, Kochi, Japan.

Correspondence to: Tetsuro Sugiura, MD, FCCP, Department of Clinical Laboratory Medicine, Kochi Medical School, Kohasu Oko-cho Nankoku City, Kochi, Japan 783-8505; e-mail: sugiurat@med.kochi-ms.ac.jp



Chest. 2003;124(6):2064-2067. doi:10.1378/chest.124.6.2064
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Study objective: The purpose of this study was to evaluate the diagnostic value of low voltage with PR-segment and ST-T wave changes in determining the amount of clinically silent pericardial effusion detected in a routine echocardiography.

Design: Consecutive case series analysis.

Setting: Noninvasive cardiology department of a university hospital.

Patients: Among 8,041 consecutive patients referred to our echocardiography laboratory, 121 asymptomatic patients with pericardial effusion free of heart disease were studied.

Interventions: Echocardiography and ECG.

Measurements and results: The amount (small or moderate/large) of pericardial effusion was correlated with ECG. Among 121 patients with pericardial effusion, low voltage was detected in 32 patients (26%), while widespread PR-segment depression was observed in 32 patients (26%) and widespread ST-segment elevation in 8 patients (7%). Although there was a significantly higher incidence of low voltage in patients with moderate/large pericardial effusion compared to that of small pericardial effusion, 13 of 32 patients (41%) with low voltage had a small pericardial effusion. In patients with a small pericardial effusion, 7 of 13 patients (54%) with low voltage had PR-segment depression, while 15 of 85 patients (18%) without low voltage had PR-segment depression; the difference was significant (p = 0.011). In patients with moderate/large pericardial effusions, there was no significant difference in the incidence of PR-segment depression between patients with and without low voltage (47% vs 25%, respectively; p = 0.791).

Conclusions: In the presence of PR-segment depression, even a small pericardial effusion may cause low voltage in the surface ECG.


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