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European Journal of Echocardiography Advance Access originally published online on January 27, 2009
European Journal of Echocardiography 2009 10(3):357-362; doi:10.1093/ejechocard/jen338
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Selective echocardiographic analysis of epicardial and endocardial left ventricular rotational mechanics in an animal model of pericardial adhesions

Mohsen S. Alharthi, Panupong Jiamsripong, Anna Calleja, Partho P. Sengupta, Eileen M. McMahon, Bijoy Khandheria, A. Jamil Tajik and Marek Belohlavek*

Translational Ultrasound Research Laboratory, Division of Cardiovascular Diseases, College of Medicine, Mayo Clinic, Johnson Research Building 3-361, 13400 E. Shea Boulevard, Scottsdale, AZ 85259, USA

Received 15 September 2008; accepted after revision 29 December 2008; online publish-ahead-of-print 27 January 2009.

* Corresponding author. Tel: +1 480 301 6694; fax: +1 480 301 9162. E-mail address: belohlavek.marek{at}mayo.edu


  Abstract

Aims: Diagnosis of pericardial adhesions is challenging. Twisting of the left ventricle (LV) is essential for normal LV functioning. We experimentally characterized the impact of pericardial adhesions on epicardial and endocardial LV rotational mechanics with velocity vector imaging (VVI).

Methods and results: In nine open-chest pigs, the heart was exposed while preserving the pericardium. Early-stage pericardial adhesions were simulated by instilling tissue glue to pericardial space. Using VVI, LV rotational mechanics was quantitatively assessed endocardially and epicardially along with haemodynamic data at baseline and following the experimental intervention. End-diastolic volume, ejection fraction, stroke volume, late diastolic filling velocity, and LV endocardial torsion decreased significantly. LV epicardial torsion showed only a trend towards decrease (P = 0.141). Endocardial twist and torsion decreased significantly (P = 0.007) from 8.6 ± 2.2 degree and 1.497 ± 0.397 degree/cm to 5.3 ± 1.8 degree and 0.97 ± 0.38 degree/cm, respectively; epicardial twist showed a trend towards a decrease in its magnitude. Gradients of endocardial/epicardial twist and torsion did not significantly change.

Conclusion: The model suggests that early-stage pericardial adhesions reduce both epicardial and endocardial LV twist and torsion without a significant alteration in their transmural gradient. Selective endocardial/epicardial analysis of LV twisting mechanics may have a diagnostic role in detection of early formation of pericardial adhesions.

Keywords: Left ventricular twist; Pericardial adhesion; Velocity vector imaging


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