Depressed right ventricular systolic function in heart failure due to constrictive pericarditis

Area of Science:

• Cardiology
• Pathology

Background:

• Constrictive pericarditis (CP) is often linked to impaired diastolic filling.
• Myocardial infiltration and fibrosis in CP can also compromise biventricular systolic function (sf).

Purpose of the Study:

• To investigate biventricular sf in patients with CP.
• To determine the impact of myocardial infiltration and fibrosis on ventricular sf in CP.

Main Methods:

• Histopathological examination of pericardium and myocardium from autopsied hearts.
• Echocardiographic assessment of biventricular sf and strain measurements in 40 CP patients and 40 controls.
• Cardiac catheterization to evaluate biventricular diastolic filling and pulmonary artery pressures.

Main Results:

• Histopathology revealed pericardial thickening, myocardial infiltration (greater in RV than LV), and associated fibrosis.
• Echocardiography showed impaired right ventricular sf (RVsf) across all indices, including strain.
• Left ventricular sf (LVsf) was preserved, despite diastolic dysfunction.

Conclusions:

• Pericardial diseases causing CP infiltrate the myocardium, affecting RVsf more than LVsf.
• Depressed RVsf due to fibrosis contributes to heart failure in CP.
• Progressive RVsf depression may indicate a higher risk for delayed pericardiectomy.