Abstract
BackgroundLeft atrial (LA) function plays an important role in the maintenance of cardiac output, however, in patients with constrictive pericarditis (CP), whether pericardial restriction and adhesion can lead to LA dysfunction, and the characteristics of LA function remain unclear. The aim of the study is to compare the left atrial (LA) function of patients with CP to that of healthy study participants using speckle tracking echocardiography (STE) and conventional echocardiography.Methods and ResultsThirty patients with CP and 30 healthy volunteers (controls) were enrolled in the study. The underlying cause of CP was viral pericarditis in 24 (80%) patients and unknown in 6 (20%) patients. The LA maximum volume (Vmax), LA minimal volume (Vmin), and LA volume before atrial contraction (Vpre-a) were measured using biplane modified Simpson’s method. The LA expansion index (LA reservoir function) was determined as follows: ([LAVmax - LAVmin]/LAVmin) ×100. The passive emptying index (LA conduit function) was calculated as follows: ([LAVmax - LAVpre-a]/LAVmax) ×100, and the active emptying index (booster pump function) was calculated as follows: ([LAVpre-a - LAVmin]/LAVpre-a) ×100. All the patients underwent two-dimensional STE. The LA global systolic strain (S), systolic strain rate (SrS), early diastolic strain rate (SrE) and late diastolic strain rate (SrA) were measured. The LA expansion index, passive emptying index, the active emptying index and the LA global S, SrS, SrE, SrA were found to be significantly lower in patients with CP than in the control participants (P <0.001). LA function was correlated with the early diastolic velocity of the lateral mitral annulus (P <0.05).ConclusionsAlthough left ventricular systolic function was preserved in patients with CP, the LA reservoir, conduit, and booster functions were impaired. Pericardial restriction and impairment of the LA myocardium may play an important role in the reduction of LA function in patients with CP.
Highlights
Chronic constrictive pericarditis (CP) is caused by reduction in the elasticity of the pericardium, which leads to impaired diastolic filling of the heart
The patients with CP included those with heart failure who were diagnosed with CP according to the echocardiographic criteria and evidence of thickened pericardium or surgically confirmed during pericardiectomy
There was no statistical difference in the left ventricular (LV) ejection fraction (LVEF) of the 2 study groups; the LV end-diastolic diameter, LV end-systolic diameter, LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV) and stroke volume (SV) were significantly decreased in the patients with CP
Summary
Chronic constrictive pericarditis (CP) is caused by reduction in the elasticity of the pericardium, which leads to impaired diastolic filling of the heart. Measurement of LA volumes, myocardial wall motion, and transmitral flow using conventional two-dimensional (2-D) and Doppler echocardiography can provide important information for the evaluation of LA function. These approaches are limited with regard to the evaluation of myocardial performance and have other technical limitations that are common to all Doppler-based techniques [1]. Left atrial (LA) function plays an important role in the maintenance of cardiac output, in patients with constrictive pericarditis (CP), whether pericardial restriction and adhesion can lead to LA dysfunction, and the characteristics of LA function remain unclear. The aim of the study is to compare the left atrial (LA) function of patients with CP to that of healthy study participants using speckle tracking echocardiography (STE) and conventional echocardiography.
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