Circulation, Vol 87, 1921-1927, Copyright © 1993 by American Heart Association
MD Tischler, M Rowan and MM LeWinter
BACKGROUND. Myocardial stretch and increased ventricular filling can lead
to increased rates of myocardial protein synthesis. In animal studies, left
ventricular mass increases after pericardiectomy, suggesting relief of a
biologically meaningful restraining role and a resultant stimulus for
growth. The present study was designed to test the hypothesis that combined
thoracotomy and pericardiotomy leads to left ventricular hypertrophy in
patients with normal left ventricular ejection fraction undergoing elective
bypass surgery. METHODS AND RESULTS. Twenty-five patients with normal left
ventricular ejection fraction without active myocardial ischemia underwent
Doppler and quantitative two-dimensional echocardiography 1 day before and
6 weeks and 7 months after elective coronary artery bypass surgery. The
pericardium was left widely incised in all patients. Left ventricular
end-systolic volume, end-diastolic volume, stroke volume, ejection
fraction, end-systolic circumferential wall stress, and mass were measured.
Left ventricular end-diastolic volume index increased from 51 +/- 11 mL/m2
to 62 +/- 14 mL/m2 (p < 0.05) at 6 weeks and to 66 +/- 14 mL/m2 (p <
0.05 versus baseline, p = NS versus 6 weeks) at 7 months. Left ventricular
mass index increased from 109 +/- 23 g/m2 to 127 +/- 24 g/m2 (p < 0.05)
at 6 weeks and to 131 +/- 23 g/m2 (p < 0.05 versus baseline, p = NS
versus 6 weeks) at 7 months. There were no changes in systolic or diastolic
blood pressures, end-systolic circumferential wall stress, or end-systolic
volume. CONCLUSIONS. Patients with normal left ventricular ejection
fraction develop increases in left ventricular end-diastolic volume and
mass after coronary artery bypass surgery. These findings support the
hypothesis that the increase in left ventricular end-diastolic volume
associated with thoracotomy and pericardiotomy leads to myocardial growth
and an increase in left ventricular mass.
ARTICLES
Increased left ventricular mass after thoracotomy and pericardiotomy. A role for relief of pericardial constraint?
Cardiology Unit, Medical Center Hospital of Vermont, Burlington 05401.
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