Elsevier

JACC: Heart Failure

Volume 7, Issue 7, July 2019, Pages 574-585
JACC: Heart Failure

State-of-the-Art Review
The Role of the Pericardium in Heart Failure: Implications for Pathophysiology and Treatment

https://doi.org/10.1016/j.jchf.2019.03.021Get rights and content
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Highlights

  • 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.

Abstract

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.

Key Words

heart failure
hemodynamics
pericardium

Abbreviations and Acronyms

HF
heart failure
HFpEF
heart failure with preserved ejection fraction
HFrEF
heart failure with reduced ejection fraction
LV
left ventricle
LVEDP
left ventricle end-diastolic pressure
LVEDV
left ventricular enddiastolic volume
NT-proBNP
N-terminal pro–B-type natriuretic peptide
PCWP
pulmonary capillary wedge pressure
PH
pulmonary hypertension
RA
right atrium
RV
right ventricle
RV-PA
right ventricle Pulmonary Arterial
RVEDP
right ventricle end-diastolic pressure

Cited by (0)

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.