title: Left atrial function is impaired in cirrhosis: a speckle tracking echocardiographic study.
abstract: OBJECTIVE
  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.
authors.affiliation: Cardiology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502, Vila Nova de Gaia, Portugal. fpasampaio@gmail.com.|Cardiovascular R&D Unit, University of Porto Medical School, Porto, Al. Prof. Hernani Monteiro, 4200-319, Porto, Portugal. fpasampaio@gmail.com.
authors.forename: Francisco
authors.initials: F
authors.lastname: Sampaio
authors.affiliation: Cardiovascular R&D Unit, University of Porto Medical School, Porto, Al. Prof. Hernani Monteiro, 4200-319, Porto, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Pimenta
authors.affiliation: Cardiology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502, Vila Nova de Gaia, Portugal.|Cardiovascular R&D Unit, University of Porto Medical School, Porto, Al. Prof. Hernani Monteiro, 4200-319, Porto, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Bettencourt
authors.affiliation: Cardiology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502, Vila Nova de Gaia, Portugal.|Cardiovascular R&D Unit, University of Porto Medical School, Porto, Al. Prof. Hernani Monteiro, 4200-319, Porto, Portugal.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Fontes-Carvalho
authors.affiliation: Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502, Vila Nova de Gaia, Portugal.
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Silva
authors.affiliation: Internal Medicine Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502, Vila Nova de Gaia, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Valente
authors.affiliation: Cardiovascular R&D Unit, University of Porto Medical School, Porto, Al. Prof. Hernani Monteiro, 4200-319, Porto, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt
authors.affiliation: Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502, Vila Nova de Gaia, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Fraga
authors.affiliation: Cardiology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502, Vila Nova de Gaia, Portugal.
authors.forename: Vasco
authors.initials: V
authors.lastname: Gama
keywords: Atrial function; Cirrhosis; Echocardiography; Heart failure; Speckle tracking imaging