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Genesis of the restrictive filling pattern: pericardial constraint or myocardial restraint

Steven J Lavine1

  • 1Cardiovascular Center, Wayne State University and University of Florida/Jacksonville, 655 W. Eighth Street, Jacksonville, FL 32209, USA. steven.lvine@jax.ufl.edu

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|January 31, 2004
PubMed

Insights

Pericardial constraint and myocardial restraint significantly influence restrictive filling patterns. Removing the pericardium altered diastolic filling dynamics, highlighting the pericardium's role in diastolic function.

Area of Science:

  • Cardiology
  • Physiology

Background:

  • Restrictive filling patterns predict heart failure in cardiomyopathy and post-myocardial infarction.
  • These patterns resemble those seen in constrictive pericarditis and amyloid heart disease.

Purpose of the Study:

  • To investigate the roles of myocardial restraint and pericardial constraint.
  • To analyze their impact in a chronic left ventricular dysfunction model with restrictive filling.

Main Methods:

  • 12 dogs with chronic left ventricular dysfunction were instrumented.
  • Intracardiac volume (ICV) was manipulated via balloon occlusion and volume loading.
  • Hemodynamics, echo-assessed chamber size, and transmitral Doppler were recorded with and without the pericardium.

Main Results:

  • With an intact pericardium, deceleration time and filling fraction varied with ICV.
  • Deceleration time correlated with intrapericardial pressure and ventricular stiffness.
  • After pericardiectomy, diastolic filling patterns changed, with reduced filling fraction.

Conclusions:

  • Both pericardial constraint and myocardial restraint contribute to restrictive filling.
  • Pericardial constraint influences diastolic filling timing, particularly after pericardiectomy.
Abstract

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