Impact of pericardial adhesions on diastolic function as assessed by vortex formation time, a parameter of transmitral flow efficiency.
BACKGROUND
Pericardial adhesions are a pathophysiological marker of constrictive pericarditis (CP), which impairs cardiac filling by limiting the total cardiac volume compliance and diastolic filling function. We studied diastolic transmitral flow efficiency as a new parameter of filling function in a pericardial adhesion animal model. We hypothesized that vortex formation time (VFT), an index of optimal efficient diastolic transmitral flow, is altered by patchy pericardial-epicardial adhesions.


METHODS
In 8 open-chest pigs, the heart was exposed while preserving the pericardium. We experimentally simulated early pericardial constriction and patchy adhesions by instilling instant glue into the pericardial space and using pericardial-epicardial stitches. We studied left ventricular (LV) function and characterized intraventricular blood flow with conventional and Doppler echocardiography at baseline and following the experimental intervention.


RESULTS
Significant decreases in end-diastolic volume, ejection fraction, stroke volume, and late diastolic filling velocity reflected the effects of the pericardial adhesions. The mean VFT value decreased from 3.61 ± 0.47 to 2.26 ± 0.45 (P = 0.0002). Hemodynamic variables indicated the inhibiting effect of pericardial adhesion on both contraction (decrease in systolic blood pressure and +dP/dt decreased) and relaxation (decrease in the magnitude of -dP/dt and prolongation of Tau) function.


CONCLUSIONS
Patchy pericardial adhesions not only negatively impact LV mechanical functioning but the decrease of VFT from normal to suboptimal value suggests impairment of transmitral flow efficiency.
Jiamsripong
Panupong
P
Translational Ultrasound Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA.
Alharthi
Mohsen S
MS
Calleja
Anna M
AM
McMahon
Eileen M
EM
Katayama
Minako
M
Westerdale
John
J
Milano
Michele
M
Heys
Jeffrey J
JJ
Mookadam
Farouk
F
Belohlavek
Marek
M
D000818:Animals; D001783:Blood Flow Velocity / Q000502:physiology*; D003971:Diastole; D004195:Disease Models, Animal; D015150:Echocardiography, Doppler / Q000379:methods*; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D010493:Pericarditis / Q000150:complications / Q000000981:diagnostic imaging*; D010496:Pericardium / Q000000981:diagnostic imaging*; D013552:Swine; D000267:Tissue Adhesions / Q000000981:diagnostic imaging; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology*