Department of Gastroenterology.
Cardiology, Tepecik Education and Research Hospital, İzmir, Turkey.
Eur J Gastroenterol Hepatol. 2021 Nov 1;33(11):1441-1450. doi: 10.1097/MEG.0000000000002129.
Cirrhotic cardiomyopathy (CCM) is a well-known entity. The aim of this study was to compare left atrial three-dimensional (3D) volume and P-wave dispersion (PWd) in patients with cirrhosis and a healthy population. The secondary purpose was to assess the left phasic volumes and reservoir functions with 3D echocardiography for the prediction of an increased risk of poor outcomes in patients with cirrhosis.
The study included 50 patients with cirrhosis and 43 healthy control subjects without atrial fibrillation. All patients were assessed with two-dimensional (2D), 3D, and tissue Doppler transthoracic echocardiography. The PWd was calculated using a 12-lead surface electrocardiogram (ECG). Cirrhotic patients were followed up for 2.5 years for the evaluation of poor outcomes and the development of atrial fibrillation.
Patients with cirrhosis were observed to have significantly higher left atrial phasic volumes such as minimal left atrial volume (3D-LAVmin, P = 0.004) and indexed LAVmin (3D-LAVImin, P = 0.0001), and significantly decreased left atrial reservoir functions such as left atrial emptying volume (3D-LAEV, P = 0,001), left atrial ejection fraction (3D-LAEF, P = 0,001) on 3D echocardiography. PWd was determined to be significantly longer in the cirrhotic group compared with the control group (P = 0.003). In the 2.5-year follow-up period, poor outcomes occurred in 34 patients (22 patients died, six patients had liver transplantation, six patients developed atrial fibrillation/AHRE episodes). In Cox regression analysis, the MELD score (HR, 1.16 (1.06-1.26), P = 0.001) and 3D-LAVImin (HR, 0.95 (0.86-1.00), P = 0.040) were significantly associated with all-cause mortality. Cirrhotic patients with LAVImin of >15 ml/m2 were seen to have poor survival (long rank P = 0.033).
The results of this study showed that patients with cirrhosis had higher left atrial volume, longer PWd and worse diastolic functions compared with the control group. Higher disease severity scores were associated with left atrial function and volume. In addition, left atrial volume measured with 3DE was a strong predictor of future adverse events, and minimal left atrial volumes had a higher prognostic value than any other left atrial function indices.
肝硬化性心肌病（CCM）是一种众所周知的病症。本研究旨在比较肝硬化患者和健康人群的左心房三维（3D）容积和 P 波离散度（PWd）。次要目的是使用 3D 超声心动图评估左房相容积和储备功能，以预测肝硬化患者发生不良预后的风险增加。
该研究纳入了 50 名肝硬化患者和 43 名无房颤的健康对照者。所有患者均接受二维（2D）、3D 和组织多普勒经胸超声心动图检查。使用 12 导联体表心电图（ECG）计算 PWd。对肝硬化患者进行 2.5 年的随访，以评估不良预后和房颤的发生情况。
与对照组相比，肝硬化患者的左心房相容积明显更高，如最小左心房容积（3D-LAVmin，P = 0.004）和指数化最小左心房容积（3D-LAVImin，P = 0.0001），且左心房储备功能明显降低，如左心房排空容积（3D-LAEV，P = 0.001）和左心房射血分数（3D-LAEF，P = 0.001）。与对照组相比，肝硬化组的 PWd 明显更长（P = 0.003）。在 2.5 年的随访期间，34 名患者发生不良预后（22 名患者死亡，6 名患者进行了肝移植，6 名患者发生了房颤/房性心动过速）。在 Cox 回归分析中，MELD 评分（HR，1.16（1.06-1.26），P = 0.001）和 3D-LAVImin（HR，0.95（0.86-1.00），P = 0.040）与全因死亡率显著相关。LAVImin ＞15ml/m2 的肝硬化患者的生存率较差（长期秩检验 P = 0.033）。
本研究结果表明，与对照组相比，肝硬化患者的左心房容积更大，PWd 更长，舒张功能更差。较高的疾病严重程度评分与左心房功能和容积相关。此外，3DE 测量的左心房容积是未来不良事件的有力预测因子，最小左心房容积比任何其他左心房功能指标都具有更高的预后价值。
