title: Pericardiectomy is Associated with Improvement in Longitudinal Displacement of Left Ventricular Free Wall Due to Increased Counterclockwise Septal-to-Lateral Rotational Displacement.
abstract: BACKGROUND
  Pericardiectomy is an effective intervention for constrictive pericarditis. Speckle-tracking echocardiography can provide quantitative information not only about longitudinal strain (LS) but about longitudinal displacement (LD) and septal-to-lateral rotational displacement (SLRD). The aim of this study was to investigate whether pericardiectomy improves myocardial mechanics using speckle-tracking analysis.
  
  
  METHODS
  Eighty-three patients with constrictive pericarditis who underwent echocardiography were retrospectively assessed (mean age, 58 ± 12 years; 72 men; 50 idiopathic, 20 postoperative, four viral, three radiation, and six others) and compared with 20 healthy volunteers. LD and SLRD were measured from the apical four-chamber view and global LS from three apical views.
  
  
  RESULTS
  LD was less in the constrictive pericarditis group compared with control subjects (P < .001). Only lateral LS was significantly less than that of control subjects (P < .001), but septal LS was similar (P = .48). In pre- and post-pericardial surgery comparisons (n = 27), values of septal and lateral LD were almost identical (mean, 13.6 ± 4.7 vs 13.3 ± 5.4 mm; P = .70) before pericardiectomy, but septal LD decreased (mean, 9.3 ± 3.5 mm; P < .001) and lateral LD increased (mean, 16.8 ± 4.7 mm; P = .0106) after the surgery, even though the difference in LS between the septal and lateral walls decreased (from 5.6 ± 5.3% to 2.5 ± 4.2%, P = .008). Systolic whole-heart swinging motion significantly increased to a counterclockwise direction after surgery (mean SLRD, -0.8 ± 3.3° vs 2.1 ± 3.0°; P = .001). Although the change in SLRD after pericardiectomy was not different between patients with decreases and increases in New York Heart Association class, SLRD change was significantly greater in patients who received fewer diuretics after surgery (mean, 4.00 ± 0.91 vs 0.27 ± 1.47; P = .027).
  
  
  CONCLUSIONS
  After surgical removal of the pericardium, LD of the septal and lateral walls became significantly different, and counterclockwise SLRD increased, reflecting loss of pericardial support.
authors.affiliation: Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Negishi
authors.affiliation: Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Zoran B
authors.initials: ZB
authors.lastname: Popović
authors.affiliation: Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Negishi
authors.affiliation: Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Motoki
authors.affiliation: Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio.
authors.forename: M Chadi
authors.initials: MC
authors.lastname: Alraies
authors.affiliation: Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Srisakul
authors.initials: S
authors.lastname: Chirakarnjanakorn
authors.affiliation: Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Arun
authors.initials: A
authors.lastname: Dahiya
authors.affiliation: Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio. Electronic address: kleina@ccf.org.
authors.forename: Allan L
authors.initials: AL
authors.lastname: Klein
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D015588:Observer Variation; D010492:Pericardiectomy / Q000379:methods*; D010494:Pericarditis, Constrictive / Q000000981:diagnostic imaging* / Q000601:surgery*; D012189:Retrospective Studies; D012399:Rotation; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*; D020257:Ventricular Remodeling / Q000502:physiology*
keywords: Constrictive pericarditis; Displacement; Longitudinal rotation; Pericardiectomy; Strain