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

Publication ,  Journal Article
Remillard, TC; Cronley, AC; Pilch, NA; Dubay, DA; Willner, IR; Houston, BA; Jackson, GR; Inampudi, C; Ramu, B; Kilic, A; Fudim, M; Wright, SP ...
Published in: Am J Cardiol
June 1, 2022

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.

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Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

June 1, 2022

Volume

172

Start / End Page

121 / 129

Location

United States

Related Subject Headings

  • Pulmonary Wedge Pressure
  • Liver Transplantation
  • Humans
  • Hemodynamics
  • Heart Failure
  • Heart Atria
  • Echocardiography
  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

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Remillard, T. C., Cronley, A. C., Pilch, N. A., Dubay, D. A., Willner, I. R., Houston, B. A., … Tedford, R. J. (2022). Hemodynamic and Clinical Determinants of Left Atrial Enlargement in Liver Transplant Candidates. Am J Cardiol, 172, 121–129. https://doi.org/10.1016/j.amjcard.2022.02.018
Remillard, Taylor C., Apryl C. Cronley, Nicole A. Pilch, Derek A. Dubay, Ira R. Willner, Brian A. Houston, Gregory R. Jackson, et al. “Hemodynamic and Clinical Determinants of Left Atrial Enlargement in Liver Transplant Candidates.Am J Cardiol 172 (June 1, 2022): 121–29. https://doi.org/10.1016/j.amjcard.2022.02.018.
Remillard TC, Cronley AC, Pilch NA, Dubay DA, Willner IR, Houston BA, et al. Hemodynamic and Clinical Determinants of Left Atrial Enlargement in Liver Transplant Candidates. Am J Cardiol. 2022 Jun 1;172:121–9.
Remillard, Taylor C., et al. “Hemodynamic and Clinical Determinants of Left Atrial Enlargement in Liver Transplant Candidates.Am J Cardiol, vol. 172, June 2022, pp. 121–29. Pubmed, doi:10.1016/j.amjcard.2022.02.018.
Remillard TC, Cronley AC, Pilch NA, Dubay DA, Willner IR, Houston BA, Jackson GR, Inampudi C, Ramu B, Kilic A, Fudim M, Wright SP, Hajj ME, Tedford RJ. Hemodynamic and Clinical Determinants of Left Atrial Enlargement in Liver Transplant Candidates. Am J Cardiol. 2022 Jun 1;172:121–129.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

June 1, 2022

Volume

172

Start / End Page

121 / 129

Location

United States

Related Subject Headings

  • Pulmonary Wedge Pressure
  • Liver Transplantation
  • Humans
  • Hemodynamics
  • Heart Failure
  • Heart Atria
  • Echocardiography
  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology