Left atrial dysfunction is an independent predictor of mortality in patients with cirrhosis treated by transjugular intrahepatic portosystemic shunt

Abstract

The present study aimed to investigate (1) the association between left ventricular diastolic dysfunction (LVDD), graded according to the algorithm proposed by the Cirrhotic Cardiomyopathy Consortium, and long‐term survival in patients with cirrhosis undergoing transjugular intrahepatic portosystemic shunt (TIPS) and (2) the additive prognostic value of left atrial (LA) function, as assessed by LA reservoir strain, using two‐dimensional speckle‐tracking echocardiography (2D‐STE). A total of 129 TIPS candidates (mean ± SD, 61 ± 12 years; 61% men) underwent a comprehensive preprocedural echocardiography. LA dysfunction was defined by LA reservoir strain ≤35%, based on a previously suggested cut‐off value. The outcome was all‐cause mortality after TIPS. In the current cohort, 65 (50%) patients had normal diastolic function, 26 (20%) patients had grade 1 LVDD, 21 (16%) patients had grade 2 LVDD, and 17 (13%) patients had indeterminate diastolic function. Additionally, LA dysfunction (based on LA reservoir strain ≤35%) was noted in 67 (52%) patients. After a median follow‐up of 36 months (range, 12–80), 65 (50%) patients died. All‐cause mortality rates increased along worse grades of LVDD (log‐rank p = 0.007) and with LA dysfunction (log‐rank p = 0.001). On multivariable Cox regression analysis, Model for End‐Stage Liver Disease score (hazard ratio [HR],1.06; p = 0.003), hemoglobin (HR, 0.74; p = 0.022), and LA strain, expressed as a continuous variable (HR, 0.96; p = 0.005) were independently associated with all‐cause mortality. Notably, the addition of LA strain to the model provided incremental prognostic value over the established prognostic variables (delta χ2 = 8.27, p = 0.004). Conclusion: LA dysfunction assessed with 2D‐STE is independently associated with all‐cause mortality in patients with cirrhosis treated by TIPS.

Diastolic Dysfunction in Cirrhotic Cardiomyopathy: A Prospective Observational Cohort Study on Short-Term Outcomes in Cirrhotic Patients Undergoing TIPS

“…Most CCM studies have been conducted in Europe and North America, where alcoholic cirrhosis predominantly causes the disease, resulting in an unclear prevalence of CCM with diastolic dysfunction in patients with hepatitis B decompensated cirrhosis. Our study revealed a 14.6% incidence of diastolic dysfunction, similar to previous research reporting CCM prevalence rates between 7.4% and 26% [7,11]. In heart diseases, it is commonly observed that left ventricular diastolic dysfunction (LVDD) precedes the onset of left ventricular systolic dysfunction, with a considerable proportion of patients with systolic dysfunction also presenting LVDD [15,16].…”

“…The Cirrhotic Cardiomyopathy Consortium (CCC) recently proposed a standardized algorithm for quantifying left ventricular diastolic function using multiple echocardiographic parameters in patients with end-stage liver disease [8]. Prior research has indicated that diastolic dysfunction prevalence ranges from 7.4-26% in populations predominantly diagnosed with alcoholic cirrhosis [7,[11][12][13]. However, data regarding patients primarily affected by hepatitis B virus (HBV) infection remains limited.…”

Prognostic impact of left ventricular global longitudinal strain in atrial mitral regurgitation

“…LV GLS and LAS were measured offline by 2D-STE and using EchoPAC V.203 software (GE-Vingmed Ultrasound), as we previously described 18…”

“…The LV endocardial border was manually traced and then automatically tracked by the software through the cardiac cycle. The LV GLS was derived by averaging all segmental strain values and later by averaging values of all apical views 14 18…”

“…After the manual definition of LA endocardial border in the apical four-chamber view, the region of interest was adjusted to cover the entire LA wall and divided into six segments by the software. The average of peak values during the cardiac cycle of all six segments identifies the LAS 18 19…”