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Prognostic Implications of Cardiac Geometry in Cirrhosis: Findings From a Large Cohort

Yu Jia1, Lidi Liu1, Yiheng Zhou1

  • 1General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China.

Liver International : Official Journal of the International Association for the Study of the Liver
|January 3, 2025
PubMed

Insights

Cardiac chamber geometry changes, including left ventricular (LV) hypertrophy and enlargement, and left atrial (LA) enlargement, are common in cirrhosis. These structural changes are linked to increased mortality and cirrhotic cardiomyopathy (CCM).

Area of Science:

  • Cardiology
  • Gastroenterology
  • Internal Medicine

Background:

  • Cirrhosis is associated with a hyperdynamic circulation and cirrhotic cardiomyopathy (CCM).
  • Previous expert consensus on CCM did not extensively consider cardiac structural changes due to limited evidence.
  • This study aimed to investigate the relationship between cardiac chamber geometry and outcomes in cirrhotic patients.

Purpose of the Study:

  • To examine the association of cardiac chamber geometry, including left ventricular (LV) hypertrophy and enlargement, and atrial enlargement, with all-cause mortality in patients with cirrhosis.
  • To determine the relationship between cardiac structural abnormalities and the prevalence of cirrhotic cardiomyopathy (CCM).

Main Methods:

  • Retrospective analysis of 2514 cirrhotic patients from 2011 to 2023.
  • Echocardiographic evaluation of LV hypertrophy (LVH) and LV, left atrial (LA), right ventricular (RV), and right atrial (RA) enlargement.
  • Cox and logistic regression analyses were used to assess associations with mortality and CCM.

Main Results:

  • Prevalence rates for LV hypertrophy, LV enlargement, LA enlargement, RV enlargement, and RA enlargement were 21.9%, 21.3%, 30.4%, 5.9%, and 10.9%, respectively.
  • Concentric LVH, eccentric LVH, LV enlargement, and LA enlargement were significantly associated with increased all-cause mortality.
  • In a subcohort, CCM (29.0% prevalence) was independently associated with LVH, LV enlargement, LA enlargement, and RA enlargement. LV abnormalities demonstrated high specificity (90%) but low sensitivity (35%) for CCM.

Conclusions:

  • Geometric alterations in the left ventricle and left atrium are prevalent in cirrhotic patients.
  • These cardiac structural changes are independent predictors of all-cause mortality and are associated with cirrhotic cardiomyopathy (CCM).
  • Cardiac geometry assessment offers potential for improved hazard stratification and redefinition of CCM.
Abstract

Keywords:
cardiac geometrycirrhosiscirrhotic cardiomyopathyleft ventricular hypertrophymortality

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