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Published on: September 15, 2023
Effect of pericardial incision on left ventricular morphology and systolic function in patients during coronary
Lan-Ting Zhao1, Lu Liu2, Ping-Ping Meng1
1Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China.
Insights
Pericardial incision during CABG alters left ventricular (LV) shape and strain parameters, impacting systolic function assessment. These changes, including decreased GLS, GCS, and twist, must be considered post-surgery.
Area of Science:
- Cardiovascular Surgery
- Echocardiography
- Cardiac Mechanics
Background:
- Accurate assessment of left ventricular (LV) systolic function is crucial post-coronary artery bypass grafting (CABG).
- LV ejection fraction (LVEF) is standard, but subtle dysfunction may be missed.
- The impact of pericardial incision during CABG on LV morphology and function is not well understood.
Purpose of the Study:
- To investigate the immediate effects of pericardial incision on LV morphology and systolic function during off-pump CABG.
Main Methods:
- Intraoperative transesophageal echocardiography was used in 27 patients before and after pericardial incision.
- Measurements included LV dimensions, sphericity index, volumes, LVEF, and deformation parameters (GLS, GCS, GRS, twist) via 2D speckle tracking.
Main Results:
- Pericardial incision increased LV mid-cavity diameter and decreased sphericity index, altering LV shape.
- Significant decreases in GLS, GCS, and twist were observed, with a notable increase in GRS.
- LV volumes and LVEF remained unchanged immediately after pericardial incision.
Conclusions:
- Pericardial incision during CABG induces immediate changes in LV morphology and strain mechanics.
- These alterations, including shape transformation and modified strain patterns, do not affect LVEF.
- Consideration of these acute changes is essential for accurate LV systolic function evaluation in post-CABG patients.
Background:
Accurate assessment of left ventricular (LV) systolic function is important after coronary artery bypass grafting (CABG). LV ejection fraction (LVEF) is conventionally used to evaluate LV systolic function; deformation parameters can be used to detect subtle LV systolic dysfunction. It is unclear whether an incised pericardium without sutures during CABG could affect LV morphology and function. We investigated the effect of pericardial incision on LV morphology and systolic function during CABG.
Methods:
Intraoperative transesophageal echocardiography was performed in 27 patients during elective off-pump beating heart CABG 5 min before and after pericardial incision. LV longitudinal and mid-cavity transversal diameters, sphericity index, volumes, and LVEF were measured. LV global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and twist obtained by two-dimensional speckle tracking echocardiography were measured simultaneously.
Results:
LV mid-cavity transversal diameter increased, while the LV sphericity index decreased (P < 0.001) immediately after pericardial incision. The GLS, GCS, and twist significantly decreased, while the GRS notably increased (P < 0.001). The LV volumes and LVEF remained unchanged.
Conclusions:
Pericardial incision immediately transformed LV morphology from an ellipsoid to sphere, with decreased longitudinal and circumferential strain and twist, and increased radial strain, while LVEF remained unchanged. This should be considered when evaluating LV systolic function in patients after CABG.
