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Updated: Nov 12, 2025
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
The prognostic value of P-wave dispersion and left atrial functions assessed with three-dimensional echocardiography
Sevil Ozersari1, Bariş Ünal2, Ali Kemal Çabuk2
1Department of Gastroenterology.
Insights
Cirrhotic cardiomyopathy is linked to enlarged left atrial volumes and prolonged P-wave dispersion. Three-dimensional echocardiography reveals minimal left atrial volume as a key predictor of poor outcomes in cirrhosis patients.
Area of Science:
- Cardiology
- Hepatology
- Medical Imaging
Background:
- Cirrhotic cardiomyopathy (CCM) is a recognized clinical entity.
- This study investigates cardiac alterations in patients with cirrhosis.
Purpose of the Study:
- Compare left atrial (LA) 3D volume and P-wave dispersion (PWd) between cirrhotic patients and healthy controls.
- Assess LA phasic volumes and reservoir function using 3D echocardiography for predicting poor outcomes in cirrhosis.
Main Methods:
- Included 50 cirrhosis patients and 43 controls, excluding those with atrial fibrillation.
- Utilized 2D, 3D, and tissue Doppler echocardiography; PWd assessed via 12-lead ECG.
- Followed cirrhotic patients for 2.5 years to evaluate outcomes and atrial fibrillation development.
Main Results:
- Cirrhotic patients showed significantly higher LA volumes (3D-LAVmin, 3D-LAVImin) and reduced LA reservoir function (3D-LAEV, 3D-LAEF) compared to controls.
- PWd was significantly longer in the cirrhotic group (P = 0.003).
- MELD score and 3D-LAVImin were significant predictors of all-cause mortality; LAVImin >15 ml/m2 indicated poor survival.
Conclusions:
- Patients with cirrhosis exhibit increased LA volume, prolonged PWd, and impaired diastolic function.
- Higher disease severity correlates with altered LA function and volume.
- 3D echocardiography-derived LA volume, particularly minimal LA volume, strongly predicts adverse events in cirrhosis.
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.
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