Effect of pericardial incision on left ventricular morphology and systolic function in patients during coronary artery bypass grafting

Abstract Background: Accurate assessment of left ventricular (LV) systolic function is important after coronary artery bypass grafting (CABG). LV ejection fraction (LVEF) is conventionally used to evaluate LV systolic function; deformation parameters can be used to detect subtle LV systolic dysfunction. It is unclear whether an incised pericardium without sutures during CABG could affect LV morphology and function. We investigated the effect of pericardial incision on LV morphology and systolic function during CABG. Methods: Intraoperative transesophageal echocardiography was performed in 27 patients during elective CABG 5 minutes before and after pericardial incision. LV longitudinal and mid-cavity transversal diameters, sphericity index, volumes, and LVEF were measured. LV global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and twist obtained by two-dimensional speckle tracking echocardiography were measured simultaneously. Results: LV mid-cavity transversal diameter increased, while the LV sphericity index decreased ( P <0.001) immediately after pericardial incision. The GLS, GCS, and twist significantly decreased, while the GRS notably increased ( P <0.001). The LV volumes and LVEF remained unchanged. The SYNTAX score was an independent predictor of reduction of GLS by >15% immediately after pericardial incision ( P <0.001). Conclusions: Pericardial incision immediately transformed LV morphology from an ellipsoid to sphere, with decreased longitudinal and circumferential strain and twist, and increased radial strain, while LVEF remained unchanged. This should be considered when evaluating LV systolic function in patients after CABG, especially in those with a lower SYNTAX score.