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Left Atrial Volume

A Novel Predictor of Hepatopulmonary Syndrome

Zamirian, Mahmood, M.D.; Aslani, Amir, M.D.; Shahrzad, Shahab, M.D.

American Journal of Gastroenterology: July 2007 - Volume 102 - Issue 7 - p 1392–1396

OBJECTIVES We studied patients with hepato-pulmonary syndrome (HPS). We found that HPS is frequently present in patients with left atrial enlargement. The aim of this prospective study was to evaluate the possible correlation between left atrial volume and HPS.

METHODS Adult patients (>18 yr old) with biopsy proven liver cirrhosis who were referred for liver transplantation were enrolled in the study. Diagnosis of HPS was established when the following points were fulfilled: (a) the presence of chronic liver disease, (b) increased alveolar-arterial difference (AaDO2), (c) intrapulmonary vascular dilatation, and (d) absence of primary cardiac or pulmonary disease.

RESULTS We enrolled 41 patients (mean age 47.1 ± 10.6 yr) diagnosed with HPS. Also 108 Child-Pugh score matched cirrhotic patients (mean age 49.2 ± 9.3 yr) who have negative contrast echocardiography and normal age-related AaDO2 were selected as a control group for the purpose of comparison of left atrial volume (LAV). LAV was significantly greater in patients with HPS compared to the control group (55.1 ± 7.5 mL vs 37.1 ± 9.3 mL, P < 0.05). The area under the receiver-operating characteristic (ROC) curve for LAV was 0.903 (Cut point ≥ 50 mL, sensitivity 86.3%, specificity 81.2%).

CONCLUSION In the context of liver cirrhosis, LAV ≥ 50 mL is a simple and feasible parameter to detect HPS.

Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran

Reprint requests and correspondence: M. Zamirian, M.D., P.O. Box 71935–1334, Namazee Hospital, Shiraz, Iran.

Received November 30, 2006; accepted February 14, 2007.

© The American College of Gastroenterology 2007. All Rights Reserved.
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