Introduction: Pericardial effusion (PEf), often clinically irrelevant, can be a common finding in heart failure (HF) patients. Despite the current data suggesting PE as a marker of severity, its role in the prognosis of HF is less well established.

Objective: Our study aimed to analyze PE as a predictor of mortality in a cohort of HF patients.

Methods: Consecutive HF patients admitted to our Cardiology Department from January 2011 to December 2014 were retrospectively included in our cohort. In-hospital mortality, readmissions, infections, malig-nancies, pericardial disease, acute coronarys syndromes and pulmonary embolism were exclusion criteria. Cardiac ultrasound, including assessment of PEf, left ventricular ejection fraction (LVEF), right ventricle to right atrium gradient (RV to RA gradient) and the systolic pulmonary artery pressure (SPAP), was performed on admission. PEf was considered if more than 2mm of pericardial fluid were present. All-cause long-term mortality was assessed after a mean follow-up of 5.5 years.

Results: Our sample included 1286 patients. Mean age was 72.14 ± 10.49 years. 52.79% were women. All-cau-se long-term mortality was 42.77%. PEf patients had an increased risk of mortality RR 1.66 (95%CI 1.41-1.96, p< 0.001). PEf patients were older (74.19 ± 10.81 vs. 71.45 ± 10.43, p= 0.02), with a lower mean LVEF (39.06 27 vs. 43.67 ± 11.52%, p= 0.002), higher median NT-proBNP levels (2502, IQR 1135-7305pg/ml vs. 1069, IQR 377.90-2524 pg/ml, p< 0.001) and longer median length of hospital stay (7, IQR 5-10 vs. 5, IQR 4-7 days, p< 0.001). They also had increased RV to RA gradient (33.27 ± 14.22 vs. 28.78 ± 12.51 mmHg, p= 0.005) and higher estimated SPAP (43.16 ± 16.81 vs. 36.21 ± 14.39 mmHg, p< 0.001). Patients with dyspnea at rest had a higher risk of associating PEf (RR 3.29, 95%CI 2.16-5.02, p< 0.001). In multivariable logistical regression with dyspnea at rest, LVEF and NT-proBNP levels, after adjusting for age and sex, the presence of PEf was an independent predictor of all-cause long-term mortality (HR 1.76, 95%CI 1.01-3.08, p= 0.045).

Conclusions: PEf was an independent predictor of long-term all-cause mortality in HF, and was associated with worse clinical presentation, higher NT-proBNP levels, lower ejection fraction and pulmonary hypertension.