title: Effect of external constraint on the index of myocardial performance in a canine model of left ventricular dysfunction.
abstract: BACKGROUND
  With left ventricular (LV) dysfunction, it is not clear how alterations in external constraint influence the index of myocardial performance (IMP). We have previously demonstrated that pericardial constraint is a factor in the production of the restrictive filling pattern. We hypothesized that altering pericardial constraint by changing intracardiac volume or removing the pericardium would produce similar directional changes in LV ejection time (LVET) and isovolumic relaxation time (IRT) resulting in minimal IMP changes.
  
  
  METHODS
  We studied 13 canines with chronic moderate LV dysfunction. LV pressures, transmitral and transaortic Doppler were obtained prior to and following pericardiectomy (PECT) with alterations of intracardiac volume, using inferior vena caval occlusion (IVCO) and volume loading.
  
  
  RESULTS
  With an intact pericardium, IVCO reduced LV size, LV end diastolic pressure (LVEDP), and increased deceleration time (all P < 0.05) but did not affect IMP. Volume loading increased LV size, LVEDP, and shortened deceleration time (all P < 0.05). LVET and IRT lengthened (P < 0.05), and IMP declined (0.58 +/- 0.24 to 0.52 +/- 0.13, P < 0.05). Following PECT, IVCO reduced LV volumes and LVEDP (P < 0.05), but did not change IMP. Volume loading increased LV size, stroke volume, and LVEDP (all P < 0.05). IMP declined (0.57 +/- 0.13 vs 0.51 +/- 0.14, P < 0.05) due to an increase in both LVET and IRT (P < 0.05). Comparison of stages prior to and following PECT revealed an increased LVET and stroke volume (P < 0.05) but a similar IMP.
  
  
  CONCLUSIONS
  Increases in intracardiac volume associated with elevated LVEDP resulted in reduced IMPs. Pericardiectomy increases LV volumes, stroke volume, and LVET but did not influence IMP.
authors.affiliation: Cardiovascular Center, University of Florida, Jacksonville, Florida 32209, USA. steven.lvine@jax.ufl.edu
authors.forename: Vafa
authors.initials: V
authors.lastname: Mansouri
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Lavine
mesh_terms: D000818:Animals; D001794:Blood Pressure; D004195:Disease Models, Animal; D004285:Dogs; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013318:Stroke Volume; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*