The importance of pericardial constraint in experimental pulmonary embolism and volume loading

Belenkie, Israel; Dani, R; Smith, Eldon R.; Tyberg, John V.

doi:10.1016/0002-8703(92)90514-v

Cited by 63 publications

(25 citation statements)

References 19 publications

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“…With non-cardiac-gated scans, while there was a degree of cardiac motion artefact, this did not adversely affect the ventricular wall detection and measurement in diastole. As reported previously by investigators from our institution [10], the patients in the major PE group also exhibited reduced cardiac motion artefact compared with the non-PE group, which is likely to reflect ventricular dyskinesis associated with major PE [29] and allows reproducible measurements, as demonstrated by the high interobserver agreement between the two observers in our study (Bland-Altman analysis; mean, 0.04, SD, 0.22). We acknowledge the limitations of scanner protocol; however, we would not expect any inaccuracies in axial measurements to alter the correlation we have shown between clot burden and degree of RV dilatation.…”

Section: Discussionsupporting

confidence: 84%

Thrombus load and acute right ventricular failure in pulmonary embolism: correlation and demonstration of a “tipping point” on CT pulmonary angiography

Wong¹,

Akram

McGurk

et al. 2012

The British Journal of Radiology

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Objectives: The aim of this study was to determine the correlation between increasing pulmonary embolism thrombus load and right ventricular (RV) dilatation as demonstrated by CT pulmonary angiography (CTPA) and to assess the thrombus load threshold which indicates impending RV decompensation. Methods: 2425 consecutive CTPAs were retrospectively analysed. Thrombus load using a modified Miller score (MMS), RV to left ventricular (RV:LV) ratio, presence of septal shift, and pulmonary artery and aorta size were analysed in 504 positive CTPA scans and a representative cohort of 100 negative scans. Results were correlated using non-parametric analysis (two-tailed t-test or x 2 test) and Pearson's rank correlation. Results: Increasing thrombus load correlated with a higher RV:LV ratio, with a statistically significant difference in RV:LV ratios between the negative and positive pulmonary embolism (PE) cohorts. Larger thrombus loads (MMS $12 vs MMS ,12) were strongly correlated with RV strain (mean RV:LV ratio, 1.323 vs 0.930; p,0.0001). Smaller thrombus loads had no significant influence on RV strain. Septal shift was also more likely with an MMS of $12, as was an increase in pulmonary artery diameter (r50.221, p,0.001). Conclusion: With increasing thrombus load in PE, there is CTPA evidence of RV decompensation with an MMS threshold of 12. This suggests a ''tipping point'' beyond which RV decompensation is more likely to occur. This is the first study to describe this tipping point between a thrombus load of MMS .12 and an increase in RV:LV ratio. This finding may help to improve risk stratification in patients with acute PE diagnosed by CTPA.

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Section: Discussionsupporting

confidence: 84%

Thrombus load and acute right ventricular failure in pulmonary embolism: correlation and demonstration of a “tipping point” on CT pulmonary angiography

Wong¹,

Akram

McGurk

et al. 2012

The British Journal of Radiology

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“…In addition to right ventricular dilatation, both factors can cause VSB. Finally, a vicious circle with a further decrease in left ventricular preload resulting in cardio-respiratory collapse may result [27,28]. Echocardiography studies revealed significant associations of VSB and mortality due to PE [3,26,29].…”

Section: Discussionmentioning

confidence: 99%

Multidetector-CT angiography in pulmonary embolism—can image parameters predict clinical outcome?

et al. 2011

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“…The importance of pericardial restraint has previously been demonstrated for the right and left ventricles and the left atrium (2,3,7,8,10,16,21,24,30,31,34). The pericardium plays an important role in ventricular interdependence (2,3,7,8,10,16,24,30,31,34), and, with respect to the left atrium, pericardiotomy induces changes in compliance that effect both passive and active ventricular filling (16,21).…”

mentioning

confidence: 99%

“…The pericardium plays an important role in ventricular interdependence (2,3,7,8,10,16,24,30,31,34), and, with respect to the left atrium, pericardiotomy induces changes in compliance that effect both passive and active ventricular filling (16,21). Previous investigators have noted that atrial compliance can substantially influence cardiac performance (20,21,23,37,39), and, whereas these studies have focused on the left atrium, the concepts are of great interest and may be applicable to the anatomically distinct right heart.…”

mentioning

confidence: 99%

Impact of pericardial restraint on right atrial mechanics during acute right ventricular pressure load

Maniar

Prasad

Gaynor

et al. 2003

American Journal of Physiology-Heart and Circulatory Physiology

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Optimization of right atrial (RA) mechanics is important for maintaining right ventricular (RV) filling and global cardiac output. However, the impact of pericardial restraint on RA function and the compensatory role of the right atrium to changes in RV afterload remain poorly characterized. In eight open-chest sheep, RA elastance (contractility) and chamber stiffness were measured (RA pressure-volume relations) at baseline and during partial pulmonary artery (PA) occlusion. Data were collected before and after pericardiotomy. With the pericardium intact and partial PA occlusion, RA elastance increased by 28% ( P < 0.04), whereas RA stiffness tended to rise ( P = 0.08). However, after pericardiotomy, there was a significant fall in both RA elastance (54%, P < 0.04) and stiffness (39%, P < 0.04), and subsequent PA occlusion failed to induce a change in elastance ( P > 0.19) or stiffness ( P > 0.84). After pericardiotomy, RA elastance and stiffness fell dramatically, and the compensatory response of the right atrium to elevated RV afterload was lost. The ability of the right atrium to respond to changes in RV hemodynamics is highly dependent on pericardial integrity.

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The importance of pericardial constraint in experimental pulmonary embolism and volume loading

Cited by 63 publications

References 19 publications

Thrombus load and acute right ventricular failure in pulmonary embolism: correlation and demonstration of a “tipping point” on CT pulmonary angiography

Thrombus load and acute right ventricular failure in pulmonary embolism: correlation and demonstration of a “tipping point” on CT pulmonary angiography

Multidetector-CT angiography in pulmonary embolism—can image parameters predict clinical outcome?

Impact of pericardial restraint on right atrial mechanics during acute right ventricular pressure load

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