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

Taylor C Remillard1, Apryl C Cronley2, Nicole A Pilch3

  • 1Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.

The American Journal of Cardiology
|March 28, 2022
PubMed

Insights

Left atrial enlargement (LAE) is common in liver transplant recipients and linked to higher stroke volume. LAE predicts a lower risk of post-transplant heart failure, and often improves after surgery.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Cardiovascular Imaging

Background:

  • New-onset heart failure is a common complication following orthotopic liver transplantation (OLT).
  • Left atrial enlargement (LAE) can indicate underlying left heart disease, potentially impacting OLT outcomes.
  • Pre-transplant cardiac assessment is crucial for managing OLT patients.

Purpose of the Study:

  • To identify predictors of pre-transplant LAE in OLT candidates.
  • To evaluate the association between LAE and post-transplant cardiovascular outcomes.
  • To determine the impact of OLT on LAE.

Main Methods:

  • Retrospective analysis of 145 OLT recipients who underwent preoperative right-sided cardiac catheterization and echocardiography.
  • Assessment of invasive hemodynamic parameters and echocardiographic measurements.
  • Statistical analysis to correlate LAE with clinical and hemodynamic factors and post-transplant outcomes.

Main Results:

  • 54% of OLT recipients had pre-transplant LAE.
  • LAE was associated with higher stroke volume index and lower systemic vascular resistance, but not pulmonary artery wedge pressure.
  • Pre-transplant LAE was linked to a significantly reduced likelihood of new-onset heart failure, hospitalization, or death within 12 months post-transplant.
  • LAE showed significant regression after OLT.

Conclusions:

  • Left atrial enlargement is prevalent in OLT candidates and correlates with stroke volume.
  • Pre-transplant LAE is paradoxically associated with a better post-transplant cardiac outcome.
  • LAE often resolves post-orthotopic liver transplantation, suggesting a dynamic cardiac remodeling process.

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