Author + information
- Received December 21, 2018
- Revision received March 15, 2019
- Accepted March 19, 2019
- Published online June 24, 2019.
- ↵∗Address for correspondence:
Dr. Barry A. Borlaug, Mayo Clinic and Foundation, 200 First Street SW, Rochester, Minnesota 55905.
• The pericardium exerts a compressive contact force on the surface of the heart that becomes exaggerated in various forms of HF where cardiac volumes increase.
• The resulting increase in pericardial restraint influences ventricular function and contributes to the hemodynamic changes that occur in HF, including the responses to vasodilation and decongestion with medical therapies.
• The right atrial pressure is a reliable surrogate for pericardial pressure and provides a clinically relevant estimate of the degree of pericardial restraint.
• A number of therapies in HF work in part through relief of relative pericardial restraint, and direct therapies including anterior pericardiotomy are undergoing investigation.
The elastic pericardium exerts a compressive contact force on the surface of the myocardium that becomes more substantial when heart volume increases, as in patients with various forms of heart failure (HF). Pericardial restraint plays an important role in determining hemodynamics and ventricular function in both health and disease. This review discusses the physiology of pericardial restraint in HF and explores the question of whether it can be targeted indirectly through medical interventions or directly through a number of existing and future therapies.
Dr. Borlaug is supported by U.S. National Institutes of Health grants R01 HL128526, R01 HL 126638, U01 HL125205, and U10 HL110262; and is named inventor on a provisional patent (#61/798,382) for the tools and approach for a minimally-invasive pericardial modification procedure to treat patients with heart failure. Dr. Reddy has reported that he has no relationships relevant to the contents of this paper to disclose.
- Received December 21, 2018.
- Revision received March 15, 2019.
- Accepted March 19, 2019.
- 2019 American College of Cardiology Foundation
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