Left atrial volume: a novel predictor of hepatopulmonary syndrome.
OBJECTIVE
We studied patients with hepato-pulmonary syndrome (HPS). We found that HPS is frequently present in patients with left atrial enlargement. The aim of this prospective study was to evaluate the possible correlation between left atrial volume and HPS.


METHODS
Adult patients (>18 yr old) with biopsy proven liver cirrhosis who were referred for liver transplantation were enrolled in the study. Diagnosis of HPS was established when the following points were fulfilled: (a) the presence of chronic liver disease, (b) increased alveolar-arterial difference (AaDO(2)), (c) intrapulmonary vascular dilatation, and (d) absence of primary cardiac or pulmonary disease.


RESULTS
We enrolled 41 patients (mean age 47.1 +/- 10.6 yr) diagnosed with HPS. Also 108 Child-Pugh score matched cirrhotic patients (mean age 49.2 +/- 9.3 yr) who have negative contrast echocardiography and normal age-related AaDO(2) were selected as a control group for the purpose of comparison of left atrial volume (LAV). LAV was significantly greater in patients with HPS compared to the control group (55.1 +/- 7.5 mL vs 37.1 +/- 9.3 mL, P < 0.05). The area under the receiver-operating characteristic (ROC) curve for LAV was 0.903 (Cut point >/= 50 mL, sensitivity 86.3%, specificity 81.2%).


CONCLUSIONS
In the context of liver cirrhosis, LAV >/= 50 mL is a simple and feasible parameter to detect HPS.
Zamirian
Mahmood
M
Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran.
Aslani
Amir
A
Shahrzad
Shahab
S
D000328:Adult; D000367:Age Factors; D001706:Biopsy; D001784:Blood Gas Analysis; D002306:Cardiac Volume / Q000502:physiology*; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D020065:Hepatopulmonary Syndrome / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index