The prognostic value of P-wave dispersion and left atrial functions assessed with three-dimensional echocardiography in patients with cirrhosis

Abstract

Background Cirrhotic cardiomyopathy (CCM) is a well-known entity. The aim of this study was to compare left atrial three-dimensional (3D) volume and P-wave dispersion (PWd) in patients with cirrhosis and a healthy population. The secondary purpose was to assess the left phasic volumes and reservoir functions with 3D echocardiography for the prediction of an increased risk of poor outcomes in patients with cirrhosis. Methods The study included 50 patients with cirrhosis and 43 healthy control subjects without atrial fibrillation. All patients were assessed with two-dimensional (2D), 3D, and tissue Doppler transthoracic echocardiography. The PWd was calculated using a 12-lead surface electrocardiogram (ECG). Cirrhotic patients were followed up for 2.5 years for the evaluation of poor outcomes and the development of atrial fibrillation. Results Patients with cirrhosis were observed to have significantly higher left atrial phasic volumes such as minimal left atrial volume (3D-LAVmin, P = 0.004) and indexed LAVmin (3D-LAVImin, P = 0.0001), and significantly decreased left atrial reservoir functions such as left atrial emptying volume (3D-LAEV, P = 0,001), left atrial ejection fraction (3D-LAEF, P = 0,001) on 3D echocardiography. PWd was determined to be significantly longer in the cirrhotic group compared with the control group (P = 0.003). In the 2.5-year follow-up period, poor outcomes occurred in 34 patients (22 patients died, six patients had liver transplantation, six patients developed atrial fibrillation/AHRE episodes). In Cox regression analysis, the MELD score (HR, 1.16 (1.06–1.26), P = 0.001) and 3D-LAVImin (HR, 0.95 (0.86–1.00), P = 0.040) were significantly associated with all-cause mortality. Cirrhotic patients with LAVImin of >15 ml/m2 were seen to have poor survival (long rank P = 0.033). Conclusion The results of this study showed that patients with cirrhosis had higher left atrial volume, longer PWd and worse diastolic functions compared with the control group. Higher disease severity scores were associated with left atrial function and volume. In addition, left atrial volume measured with 3DE was a strong predictor of future adverse events, and minimal left atrial volumes had a higher prognostic value than any other left atrial function indices.

Adults with Crohn’s disease exhibit elevated gynoid fat and reduced android fat irrespective of disease relapse or remission

“…In recognition of the importance of physical activity in preventing sarcopenia, obesity and general well-being in CD 37 , 38 we employed wearable sensors to determine the physical activity levels of our study participants. Notably, while our initial expectation was that physical activity may be lower in the CD setting overall and especially in relapse 39 , our results showed a general level of activity in line with, or exceeding, that of the general population.…”

The effect of empagliflozin on P wave peak time and other P wave parameters in patients with diabetes mellitus

“…35 LA volume is a sign of diastolic and systolic dysfunction and a marker of atrial remodeling. 36 Prolonged PWPT, PWD, PWdis, and abnormal PWTF have all been linked to PAF in previous studies. 15,16 Sato et al found reduced PWD and PWdis after dapagliflozin treatment and attributed the effect to volume changes in epicardial adipose tissue.…”

“…LA enlargement and decreased LA function are predictors of atrial fibrillation, stroke, and death 35 . LA volume is a sign of diastolic and systolic dysfunction and a marker of atrial remodeling 36 . Prolonged PWPT, PWD, PWdis, and abnormal PWTF have all been linked to PAF in previous studies 15,16 .…”

“…Significant reductions were observed in HbA1c (p < .001), triglyceride (p < .001), and total cholesterol (p = .02) whereas hematocrit (p < .001) and platelet count (p = .001) were significantly higher. The clinical findings and laboratory parameters of the patients are shown in Table2.LA volume (42[36][37][38][39][40][41][42][43][44][45][46][47] vs. 40[33][34][35][36][37][38][39][40][41][42][43][44], p < .001), LA diameter both in parasternal long axis(38 [36.5-42] vs. 38[35][36][37][38][39][40][41], p = .001) and apical four chamber view(37 [33-41] vs. 37[30][31][32][33][34][35][36][37][38][39], p = .027) were decreased after treatment compared to baseline. E/e′ (6.8 [5.9-9.4] vs. 5.92[4.96-7.74], p = .001), systolic pulmonary arterial pressure (sPAP) (20[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]…”

Can Multi-organ Sonographic Parameters Predict Mortality in Patients With Acute Kidney Injury?

“…14 Other studies have reported no difference in baseline cardiac echo findings, in terms of mortality or AKI in the long-term follow-up of cirrhosis. 15,16 Since the LV dimensions in the two groups (e.g., median LV dimensions of 40 mm in the mortality and 43 mm in the non-mortality groups) were similar, with a slight statistical difference between them. Based on this cohort's LV dimensions, it would seem that the clinical utility of this measurement would be limited.…”