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[Study on right and left atrial dynamics in chronic constrictive pericarditis by esophageal echocardiography]
Insights
Chronic constrictive pericarditis (CP) impairs atrial function, decreasing active shortening and passive enlargement. This suggests the atria primarily act as conduits in CP patients.
Area of Science:
- Cardiology
- Physiology
- Medical Imaging
Context:
- Chronic constrictive pericarditis (CP) affects cardiac function.
- Atrial dynamics are crucial for effective cardiac output.
- Esophageal echocardiography allows detailed atrial assessment.
Purpose:
- To evaluate atrial dynamics in patients with chronic constrictive pericarditis (CP).
- To compare atrial function in CP patients versus normal subjects.
- To investigate the impact of CP on atrial compliance and contractility.
Summary:
- Esophageal echocardiography revealed no significant difference in end-diastolic atrial dimensions between normal subjects and CP patients, despite elevated pressures.
- Active atrial shortening and passive atrial enlargement were significantly impaired in CP patients.
- These findings suggest reduced atrio-pericardial compliance and altered atrial mechanics in CP, leading to a conduit function.
Impact:
- Demonstrates impaired active and passive atrial function in chronic constrictive pericarditis.
- Highlights the role of atrial mechanics in the pathophysiology of CP.
- Provides insights into the functional consequences of pericardial disease on atrial hemodynamics.
Abstract:
In 9 normal subjects (N) and 4 patients with chronic constrictive pericarditis (CP) with normal sinus rhythm, esophageal echocardiography was performed to obtain simultaneous echograms of the right atrial free wall and the interatrial septum, and both atrial dynamics were evaluated. In spite of increased mean right atrial and mean pulmonary arterial wedge pressures in CP, there were no significant differences in left, right and total atrial end-diastolic dimensions between N and CP. This indicates that there is a decrease in compliance of atrio-pericardial system in CP. Atrial shortening of both atria during active atria contraction was decreased in CP, while there was no significant difference in atrial dimension measured at the beginning of the active atrial shortening between N and CP. This impaired pump function might be due to increased ventricular late-diastolic pressure or organic change in the atrial muscle. The passive enlargement of both atria was impaired during atrial filling phase in CP. Thus, it was concluded that in CP the active shortening and passive enlargement of the right and left atria are decreased, and the atria tend to be a conduit.