Wiese Signe, Liang Mark, Mo Silje, Bendtsen Flemming, Hove Jens D, Møller Søren
Center of Functional Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, University of Copenhagen, Kettegaard Alle 30, 2650, Hvidovre, Denmark.
Gastro Unit, Medical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
Int J Cardiovasc Imaging. 2020 Nov;36(11):2121-2127. doi: 10.1007/s10554-020-01920-7. Epub 2020 Jul 1.
Left atrial enlargement is a known marker of chronic diastolic dysfunction and was recently shown to be an independent predictor of mortality in cirrhosis. Real time 3-dimensional echocardiography (3DE) is an emerging modality that enables accurate measurements of the left atrial (LA) volume and function. Assessment of LA volumes with 3DE has never been applied in cases of cirrhosis. We therefore aimed to investigate LA volumes using the novel 3DE technique in relation to liver dysfunction and outcome in patients with cirrhosis. A prospective study of 47 cirrhotic patients without cardiovascular disease and ten healthy controls. The patients underwent clinical evaluation, blood sampling, liver vein catheterization, ECG and tissue Doppler echocardiography, including 3DE. Patients were followed up for a median of 25 months with registration of death and liver transplantation (LT). 3DE-derived maximal left atrial volume index (LAVI) and minimal left atrial volume index (LAVI) were higher in patients with a Child Pugh score of 8 or higher than in patients with a score lower than 8 (30.0 vs. 22.3 mL/m, P=0.008 and 14.6 vs. 9.5 mL/m, P=0.04, respectively). LA volumes correlated with model for end-stage liver disease (MELD) score (r=0.40, P=0.005), hepatic venous pressure gradient (r=0.34, P=0.04), and biochemical markers of advanced liver disease. Twelve patients experienced the composite end-point of death or LT during follow-up and these patients had increased LA volumes with a higher LAVI (34.3±14.8 vs. 25.9±7.3 mL/m, P=0.01) and a higher LAVI (16.3±7.3 vs. 10.8±5.1 mL/m, P=0.007). Patients with advanced cirrhosis have increased minimal and maximal left atrial volumes, which correlate with the degree of the liver dysfunction and poor prognosis.
左心房增大是慢性舒张功能障碍的已知标志，最近被证明是肝硬化患者死亡率的独立预测因素。实时三维超声心动图（3DE）是一种新兴的检查方法，能够准确测量左心房（LA）容积和功能。3DE评估LA容积从未应用于肝硬化病例。因此，我们旨在使用新型3DE技术研究肝硬化患者的LA容积与肝功能障碍及预后的关系。对47例无心血管疾病的肝硬化患者和10名健康对照者进行了一项前瞻性研究。患者接受了临床评估、血液采样、肝静脉插管、心电图和组织多普勒超声心动图检查，包括3DE检查。对患者进行了中位时间为25个月的随访，记录死亡和肝移植（LT）情况。Child-Pugh评分为8分或更高的患者，其3DE得出的最大左心房容积指数（LAVI）和最小左心房容积指数高于评分低于8分的患者（分别为30.0 vs. 22.3 mL/m²，P = 0.008和14.6 vs. 9.5 mL/m²，P = 0.04）。LA容积与终末期肝病模型（MELD）评分（r = 0.40，P = 0.005）、肝静脉压力梯度（r = 0.34，P = 0.04）以及晚期肝病的生化标志物相关。12例患者在随访期间经历了死亡或LT的复合终点，这些患者的LA容积增加，LAVI更高（34.3±14.8 vs. 25.9±7.3 mL/m²，P = 0.01），LAVI也更高（16.3±7.3 vs. 10.8±5.1 mL/m²，P = 0.007）。晚期肝硬化患者的最小和最大左心房容积增加，这与肝功能障碍程度和不良预后相关。
