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Heart. 1996 February; 75(2): 184–189.
PMCID: PMC484257

Collagen network remodelling and left ventricular function in constrictive pericarditis.


OBJECTIVE: To investigate whether patients with constrictive pericarditis have changes in collagen content and architecture that could influence left ventricular function. DESIGN: Cohort study. SETTING: University teaching hospital. PATIENTS: Biopsy specimens of myocardium from 13 patients admitted consecutively for treatment of chronic constrictive pericarditis were compared with normal heart tissue taken at necropsy from 15 patients free of cardiac disease. INTERVENTION: Pericardiectomy through median sternotomy. Biopsy specimens (4 or 5) were taken from the left ventricular free wall. MAIN OUTCOME MEASURES: Biochemical and histological assessment of total collagen content, relative proportion of type I and III collagen, and amount of orthogonal collagen fibre meshwork (crosshatching) in the left ventricular tissue. RESULTS: There was more collagen in the myocardium of patients with constrictive pericarditis than in controls when measured either biochemically by hydroxyproline content (89.4 v 50.4 mg/g dry weight) or by histological measurement of the collagen fraction of the myocardium (2.4% v 7.0%). Neither of these measurements, however, correlated with left ventricular ejection fraction, pulmonary wedge pressure, or right ventricular end diastolic pressure. The thickness of the fibrous trabeculae in the myocardium was, however, inversely related to both left ventricular ejection fraction (r = -0.76) and deceleration time (r = -0.68). Trabecular thickening was also related to NYHA class, with those in class III and IV having the greatest thickening. CONCLUSION: Changes in collagen content and architecture may contribute to impaired ventricular function in patients with chronic constrictive pericarditis.

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  • McCaughan BC, Schaff HV, Piehler JM, Danielson GK, Orszulak TA, Puga FJ, Pluth JR, Connolly DC, McGoon DC. Early and late results of pericardiectomy for constrictive pericarditis. J Thorac Cardiovasc Surg. 1985 Mar;89(3):340–350. [PubMed]
  • DeValeria PA, Baumgartner WA, Casale AS, Greene PS, Cameron DE, Gardner TJ, Gott VL, Watkins L, Jr, Reitz BA. Current indications, risks, and outcome after pericardiectomy. Ann Thorac Surg. 1991 Aug;52(2):219–224. [PubMed]
  • Miller JI, Mansour KA, Hatcher CR., Jr Pericardiectomy: current indications, concepts, and results in a university center. Ann Thorac Surg. 1982 Jul;34(1):40–45. [PubMed]
  • Viola AR. The influence of pericardiectomy on the hemodynamics of chronic constrictive pericarditis. Circulation. 1973 Nov;48(5):1038–1042. [PubMed]
  • Kloster FE, Crislip RL, Bristow JD, Herr RH, Ritzmann LW, Griswold HE. Hemodynamic studies following pericardiectomy for constrictive pericarditis. Circulation. 1965 Sep;32(3):415–424. [PubMed]
  • Thiedemann KU, Holubarsch C, Medugorac I, Jacob R. Connective tissue content and myocardial stiffness in pressure overload hypertrophy. A combined study of morphologic, morphometric, biochemical, and mechanical parameters. Basic Res Cardiol. 1983 Mar-Apr;78(2):140–155. [PubMed]
  • Caulfield JB, Borg TK. The collagen network of the heart. Lab Invest. 1979 Mar;40(3):364–372. [PubMed]
  • Oldershaw PJ, Brooksby IA, Davies MJ, Coltart DJ, Jenkins BS, Webb-Peploe MM. Correlations of fibrosis in endomyocardial biopsies from patients with aortic valve disease. Br Heart J. 1980 Dec;44(6):609–611. [PMC free article] [PubMed]
  • Anderson KR, Sutton MG, Lie JT. Histopathological types of cardiac fibrosis in myocardial disease. J Pathol. 1979 Jun;128(2):79–85. [PubMed]
  • Frederiksen DW, Hoffnung JM, Frederiksen RT, Williams RB. The structural proteins of normal and diseased human myocardium. Circ Res. 1978 Apr;42(4):459–466. [PubMed]
  • Oh JK, Hatle LK, Seward JB, Danielson GK, Schaff HV, Reeder GS, Tajik AJ. Diagnostic role of Doppler echocardiography in constrictive pericarditis. J Am Coll Cardiol. 1994 Jan;23(1):154–162. [PubMed]
  • Stegemann H, Stalder K. Determination of hydroxyproline. Clin Chim Acta. 1967 Nov;18(2):267–273. [PubMed]
  • Laurent GJ, Cockerill P, McAnulty RJ, Hastings JR. A simplified method for quantitation of the relative amounts of type I and type III collagen in small tissue samples. Anal Biochem. 1981 May 15;113(2):301–312. [PubMed]
  • Junqueira LC, Cossermelli W, Brentani R. Differential staining of collagens type I, II and III by Sirius Red and polarization microscopy. Arch Histol Jpn. 1978 Jun;41(3):267–274. [PubMed]
  • Villari B, Campbell SE, Hess OM, Mall G, Vassalli G, Weber KT, Krayenbuehl HP. Influence of collagen network on left ventricular systolic and diastolic function in aortic valve disease. J Am Coll Cardiol. 1993 Nov 1;22(5):1477–1484. [PubMed]
  • Stalpaert G, Suy R, Daenen W, Nevelsteen A. Total pericardectomy for chronic constrictive pericarditis. Early and late results. Acta Chir Belg. 1981 Sep-Oct;80(5):277–282. [PubMed]
  • Somerville W. Constrictive pericarditis. With special reference to the change in natural history brought about by surgical intervention. Circulation. 1968 Jul;38(1 Suppl):102–110. [PubMed]
  • Meaney E, Shabetai R, Bhargava V, Shearer M, Weidner C, Mangiardi LM, Smalling R, Peterson K. Cardiac amyloidosis, contrictive pericarditis and restrictive cardiomyopathy. Am J Cardiol. 1976 Nov 4;38(5):547–556. [PubMed]
  • Levine HD. Myocardial fibrosis in constrictive pericarditis. Electrocardiographic and pathologic observations. Circulation. 1973 Dec;48(6):1268–1281. [PubMed]
  • DINES DE, EDWARDS JE, BURCHELL HB. Myocardial atrophy in constrictive pericarditis. Proc Staff Meet Mayo Clin. 1958 Feb 19;33(4):93–99. [PubMed]
  • Talwar KK, Narula JP, Chopra P. Myocarditis and myocardial interstitial fibrosis in constrictive pericarditis--an extended pathological spectrum? Int J Cardiol. 1990 Nov;29(2):241–243. [PubMed]
  • Whittaker P, Boughner DR, Kloner RA. Analysis of healing after myocardial infarction using polarized light microscopy. Am J Pathol. 1989 Apr;134(4):879–893. [PubMed]
  • Bishop JE, Greenbaum R, Gibson DG, Yacoub M, Laurent GJ. Enhanced deposition of predominantly type I collagen in myocardial disease. J Mol Cell Cardiol. 1990 Oct;22(10):1157–1165. [PubMed]
  • Badeer HS. Development of cardiomegaly. A unifying hypothesis explaining the growth of muscle fibers, blood vessels and collagen of heart. Cardiology. 1972;57(5):247–261. [PubMed]
  • Weber KT. Cardiac interstitium in health and disease: the fibrillar collagen network. J Am Coll Cardiol. 1989 Jun;13(7):1637–1652. [PubMed]
  • Weber KT, Brilla CG. Pathological hypertrophy and cardiac interstitium. Fibrosis and renin-angiotensin-aldosterone system. Circulation. 1991 Jun;83(6):1849–1865. [PubMed]
  • Jalil JE, Janicki JS, Pick R, Abrahams C, Weber KT. Fibrosis-induced reduction of endomyocardium in the rat after isoproterenol treatment. Circ Res. 1989 Aug;65(2):258–264. [PubMed]
  • Jalil JE, Doering CW, Janicki JS, Pick R, Shroff SG, Weber KT. Fibrillar collagen and myocardial stiffness in the intact hypertrophied rat left ventricle. Circ Res. 1989 Jun;64(6):1041–1050. [PubMed]
  • BRAUNWALD E, SARNOFF SJ, CASE RB, STAINSBY WN, WELCH GH., Jr Hemodynamic determinants of coronary flow: effect of changes in aortic pressure and cardiac output on the relationship between myocardial oxygen consumption and coronary flow. Am J Physiol. 1958 Jan;192(1):157–163. [PubMed]
  • Stewart JR, Fajardo LF. Radiation-induced heart disease. Clinical and experimental aspects. Radiol Clin North Am. 1971 Dec;9(3):511–531. [PubMed]
  • Comstock JP, Udenfriend S. Effect of lactate on collagen proline hydroxylase activity in cultured L-929 fibroblasts. Proc Natl Acad Sci U S A. 1970 Jun;66(2):552–557. [PubMed]

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