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1 Department of Biomedical Engineering, Washington University, St Louis, MO, USA
2 Cardiovascular Biophysics Laboratory and Cardiovascular MR Laboratories, Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine, St Louis, MO, USA
3 Cardiovascular Biophysics Laboratory and Cardiovascular MR Laboratories, Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine, St Louis, MO, USA; Department of Biomedical Engineering, Washington University, St Louis, MO, USA
* To whom correspondence should be addressed. E-mail: sjk{at}wuphys.wustl.edu.
During one cardiac cycle, the volume encompassed by the pericardial sack in healthy subjects remains nearly constant, with a transient ~5% decrease in volume at endsystole. This "constant-volume" attribute defines a constraint which the longitudinal vs. radial pericardial contour dimension relationship must obey. Using cardiac MRI, we determined the extent to which the constant-volume attribute is valid from four-chamber slices (2D) compared to three-dimensional (3D) volumetric data. We also compared the relative percentage of longitudinal vs. radial (short-axis) change in cross-sectional area (dimension) of the pericardial contour, thereby assessing the fate of the ~5% end-systolic volume decrease. Images from ten normal volunteers and one subject with congenital absence of the pericardium, obtained using a 1.5 T MR scanner, were analyzed. Shortaxis cine-loop stacks covering the entire heart were acquired, as were single fourchamber cine-loops. In the short-axis and four-chamber slices, relative to mid-ventricular end-diastolic location, maximum end-systolic pericardial (left ventricular epicardial)displacement was observed to be radial, occuring near end-systole. Longitudinal (apexto- mediastinum) pericardial contour dimension change and pericardial area change on the four-chamber slice were negligible throughout the cardiac cycle. We conclude the ~5% end-systolic decrease in the volume encompassed by the pericardial sack is primarily accounted for by a "crescent effect" on short-axis views, manifesting as a nonisotropic radial diminution of the pericardial/epicardial contour of the left ventricle. This systolic drop in cardiac volume occurs primarily at the ventricular level and is made up during the subsequent diastole when blood crosses the pericardium in the pulmonary venous Doppler D-wave during early rapid left ventricular filling.
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