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Changes in Left Atrial Mechanics Following Pericardiectomy for Pericardial Constriction

Citation

Motoki, H and Alraies, MC and Dahiya, A and Saraiva, RM and Hanna, M and Marwick, TH and Klein, AL, Changes in Left Atrial Mechanics Following Pericardiectomy for Pericardial Constriction, Journal of the American Society of Echocardiography, 26, (6) pp. 640-648. ISSN 0894-7317 (2013) [Refereed Article]

Copyright Statement

Copyright 2013 American Society of Echocardiography

DOI: doi:10.1016/j.echo.2013.02.014

Abstract

Background: Although impaired left ventricular (LV) filling in constrictive pericarditis (CP) is attributable to external constraints by a tethered pericardium, impaired left atrial (LA) function can further impair LV filling. Previous studies focused on the impact of a tethered pericardium on LV diastolic behavior, but its impact on LA function has been largely overlooked. The objectives of this study were to evaluate LA mechanics in CP and to assess the impact of pericardiectomy on LA mechanics. Methods: A total of 52 patients with CP (mean age, 57 ± 12 years) and 19 control subjects were studied retrospectively. All patients with CP underwent echocardiography before (median, 12 days; interquartile range, 5-34 days) and after pericardiectomy (median, 20 days; interquartile range, 5-64 days). Global LA longitudinal strain (ε) was calculated, which included peak negative ε (εnegative), peak positive ε (εpositive), and the sum of those values, total LA ε (εtotal), using speckle-tracking echocardiography with Velocity Vector Imaging. The regional difference of LA ε between the septal and lateral walls was assessed before and after the procedure. Results: Patients with CP showed depressed global LA εnegative, LA εtotal, and LA εpositive compared with controls. LA contractile (global LA εnegative) and reservoir functions (global LA εtotal) showed significant increases after pericardiectomy. Regional analysis revealed that the improvement in LA function after surgery was more apparent in lateral segments, while the regional function of septal walls was depressed after surgery. Conclusions: Patients with CP have impaired LA mechanics, presumably because of the constrictive tethering process involving the left atrium. Speckle-tracking echocardiography showed consistent results of changes in LA mechanics with conventional echocardiographic parameters early after the procedure. Regional ε analysis aided in recognition of the impact of constrictive tethering and pericardiectomy on LA function. © 2013 American Society of Echocardiography.

Item Details

Item Type:Refereed Article
Keywords:Left atrial function, Strain, Speckle-tracking echocardiography, Constrictive Pericarditis, Pericardiectomy
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Marwick, TH (Professor Tom Marwick)
ID Code:85304
Year Published:2013
Web of Science® Times Cited:9
Deposited By:Menzies Institute for Medical Research
Deposited On:2013-06-26
Last Modified:2013-08-27
Downloads:0

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