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Diastolic hibernation masquerading as constrictive pericarditis
B S Cain1, D R Meldrum, K S Joo
1Department of Surgery, University of Colorado, Denver 80262, USA.
Insights
Diastolic hibernation, a reversible impairment of myocardial contractility, was observed in a patient with coronary artery disease. Surgical intervention corrected this condition, suggesting a new form of treatable restrictive cardiomyopathy.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiomyopathy Research
Background:
- Hibernating myocardium traditionally linked to systolic dysfunction.
- Constrictive pericarditis diagnosis in a 75-year-old patient with coronary artery disease.
- Exploration of non-systolic dysfunction in myocardial hibernation.
Observation:
- Patient presented with significant coronary artery disease.
- Initial diagnosis of constrictive pericarditis.
- Sternotomy revealed no pericarditis but significant diastolic dysfunction.
Findings:
- Coronary revascularization led to immediate improvement in diastolic function.
- Ex vivo analysis showed normal myocardial adrenergic responsiveness.
- Demonstrated a reversible impairment of myocardial contractility.
Implications:
- Diastolic hibernation as a distinct clinical entity.
- Potential for surgical correction of this condition.
- Highlights a novel form of restrictive cardiomyopathy.
Background:
Hibernating myocardium has traditionally been characterized in terms of systolic dysfunction.
Methods:
We describe a case in which a 75-year-old patient with significant coronary artery disease was operated upon for classic constrictive pericarditis.
Results:
At sternotomy, there was no evidence of pericarditis, but marked diastolic without systolic dysfunction remained. After successful coronary revascularization, the patient immediately exhibited dramatic improvement of diastolic performance. Ex vivo evaluation of myocardial contractile function revealed normal myocardial adrenergic responsiveness, indicating a reversible impairment of contractility.
Conclusion:
Diastolic hibernation may therefore represent a unique form of surgically correctable restrictive cardiomyopathy.