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Left atrial function is impaired in cirrhosis: a speckle tracking echocardiographic study

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Abstract

Purpose

Abnormalities in left ventricular systolic and diastolic function have been described in patients with cirrhosis. There are no studies on left atrial (LA) function in these patients. We aimed to evaluate LA function in cirrhosis patients using myocardial deformation imaging.

Methods

We included 111 hospitalized and ambulatory patients with cirrhosis and 18 healthy controls. A comprehensive echocardiographic evaluation was performed; LA strain was assessed using velocity vector imaging.

Results

Peak atrial longitudinal strain at the end of ventricular systole was lower in patients [41.9 % (34.4–51.0) vs. 48.0 % (42.0–57.1), p = 0.02]. No differences were found in atrial strain before atrial contraction in patients and controls [17.5 % (14.3–22.4) vs. 20.7 % (14.1–26.3), p = 0.14]. On multivariate linear regression analysis, E′ velocity was the only variable independently associated with peak atrial longitudinal strain (R 2 = 47 %). No correlation was found between the LA volume index (LAVI) and peak atrial longitudinal strain (r = −0.136, p = 0.219). Peak atrial longitudinal strain performed better than LAVI in identifying patients with elevated filling pressures (AUC = 0.81 vs. 0.52).

Conclusions

Patients with cirrhosis have abnormal atrial reservoir function, which may be related to the same factors associated with impaired ventricular relaxation. LA enlargement in cirrhosis may not reflect elevated filling pressures and should not be used as an isolated marker of diastolic dysfunction. The atrial “pump” function does not seem to be affected in cirrhosis patients.

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Conflict of interest

Francisco Sampaio, Joana Pimenta, Nuno Bettencourt, Ricardo Fontes-Carvalho, Ana Paula Silva, João Valente, Paulo Bettencourt, José Fraga and Vasco Gama declare that they have no conflict of interest.

Compliance with Ethical Requirements

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Cardiology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502, Vila Nova de Gaia, Portugal

    Francisco Sampaio, Nuno Bettencourt, Ricardo Fontes-Carvalho & Vasco Gama

  2. Internal Medicine Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502, Vila Nova de Gaia, Portugal

    João Valente

  3. Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502, Vila Nova de Gaia, Portugal

    Ana Paula Silva & José Fraga

  4. Cardiovascular R&D Unit, University of Porto Medical School, Porto, Al. Prof. Hernani Monteiro, 4200-319, Porto, Portugal

    Francisco Sampaio, Joana Pimenta, Nuno Bettencourt, Ricardo Fontes-Carvalho & Paulo Bettencourt

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  1. Francisco Sampaio
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  2. Joana Pimenta
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Correspondence to Francisco Sampaio.

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Sampaio, F., Pimenta, J., Bettencourt, N. et al. Left atrial function is impaired in cirrhosis: a speckle tracking echocardiographic study. Hepatol Int 8, 146–153 (2014). https://doi.org/10.1007/s12072-013-9469-5

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  • DOI: https://doi.org/10.1007/s12072-013-9469-5

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