Effect of end-stage liver disease on left atrial function

Abstract

Background Hepatic cirrhosis causes structural and functional myocardial changes. Parameters of left atrial (LA) function provided novel insights and have prognostic significance in many cardiac patients. 2D speckle tracking echocardiography and tissue Doppler imaging (TDI) technique supported a comprehensive method for examining the LA function. The aim of this study was to investigate phasic LA functions in end-stage hepatic cirrhosis using echo-Doppler and strain imaging techniques in participants with preserved left ventricular (LV) ejection fraction. Patients and methods This study included 50 patients with end-stage hepatic cirrhosis based on Child-Pugh score having normal LV systolic function, in addition to 35 healthy individuals as a control group. All the studied cases underwent LV conventional echo-Doppler imaging measurements and LA dimensions and volumetric measurements, together with TDI-derived left atrial strain (TDLA strain), speckle tracking echo-derived left atrial global strain (LAGST), and peak LA systolic myocardial velocity (LA Sm4) averaged from 4 LA myocardial sites. Results There was a highly significant increase of LVIDd and LVIDS and significant increase of MA vel in group I, whereas there was a highly significant decrease of ME vel and ME/A ratio in group I. Group I had highly significant increase in LA dimensions (anteroposterior and superior inferior) and significant increase in LA mediolateral diameter. Moreover, there was a significant increase in LA volumes and volumic indices (LAVmax, LAVI, LAVmin, LAVI min, LAV pre-A, and LAVI pre-A) in group I. Conclusion LA function is impaired in patients with end-stage liver disease. 2D strain and TDI-derived strain are useful echomodalities for assessment of LA function.