Abstract 549: Impact of Pericardial Adhesions on Peak Apical Left Ventricular Diastolic Rotation Rate
Background: Pericardial adhesions can negatively impact diastolic filling. We hypothesized that peak apical diastolic left ventricular (LV) rotation rate, which typically occurs in early diastole, would be reduced due to the constricting effects of pericardial-epicardial adhesions on the LV during systolic twisting and subsequent diastolic recoil. The aim was to experimentally simulate pericardial adhesions and test the hypothesis.
Methods: In 8 open-chest anesthetized adult pigs, the heart was exposed while preserving the pericardium, and pericardial adhesions were induced by 8 to 12 Prolene pericardial-epicardial stitches and tissue glue instilled into the apical pericardial space. Using Velocity Vector Imaging, we assessed peak apical diastolic LV rotation and untwisting rates and hemodynamic data at baseline and following the induced pericardial adhesions.
Results: Table⇓, Neither changes in mean aortic pressure (MAP) or heart rate (HR), nor changes in some “traditional” parameters of diastolic function, including E/A ratio and LV end-diastolic pressure (LVEDP), were significant. However, the effect of simulated pericardial adhesions was signified by a decrease in cardiac output (CO), peak negative LV pressure change rate (−dP/dt), ejection fraction (EF), and LV end-diastolic volume (LVEDV), as well as by an increase in the time constant of LV pressure decay (Tau). The peak basal diastolic LV rotation rates did not change, while peak apical diastolic LV rotation rates did decrease significantly, resulting in a decrease of LV untwisting velocity.
Conclusion: In a model of early stages of pericardial adhesions, reduction in the peak apical diastolic LV rotation rate was a noninvasively measurable functional marker of the pericardial pathology and led to the decrease in the rate of LV untwisting.