Hemodynamic and Clinical Determinants of Left Atrial Enlargement in Liver Transplant Candidates

Taylor C. Remillard, Apryl C. Cronley, Nicole A. Pilch, Derek A. Dubay, Ira R. Willner, Brian A. Houston, Gregory R. Jackson, Chakradhari Inampudi, Bhavadharini Ramu, Arman Kilic, Marat Fudim, Stephen P. Wright, Milad El Hajj, Ryan J. Tedford

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

New-onset heart failure is a frequent complication after orthotopic liver transplantation (OLT). Left atrial enlargement (LAE) may be a sign of occult left heart disease. Our primary objective was to determine invasive hemodynamic and clinical predictors of LAE and then investigate its effect on post-transplant outcomes. Of 609 subjects who received OLT between January 1, 2010, and October 1, 2018, 145 who underwent preoperative right-sided cardiac catheterization and transthoracic echocardiography were included. Seventy-eight subjects (54%) had pretransplant LAE. Those with LAE had significantly lower systemic vascular resistance with higher cardiac and stroke volume index (61.0 vs 51.7 ml/m2; p <0.001), but there was no difference in pulmonary artery wedge pressure. There was a linear relation between left atrial volume index and stroke volume index (R2 = 0.490, p<0.001), but not pulmonary artery wedge pressure. The presence of severe LAE was associated with a reduced likelihood (hazard ratio = 0.26, p = 0.033) of reaching the composite end point of new-onset systolic heart failure, heart failure hospitalization, or heart failure death within 12 months post-transplant. There was also a significant reduction in LAE after transplantation (p = 0.013). In conclusion, LAE was common in OLT recipients and was more closely associated with stroke volume than left heart filling pressures. The presence of LAE was associated with a reduced likelihood of reaching composite outcomes and tended to regress after transplant.

Original languageEnglish (US)
Pages (from-to)121-129
Number of pages9
JournalAmerican Journal of Cardiology
Volume172
DOIs
StatePublished - Jun 1 2022
Externally publishedYes

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© 2022 Elsevier Inc.

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