The Value Of Real-Time Three-Dimensional Ultrasound Technology To Evaluate Left Atrial Volume And Function In Patients With Liver Cirrhosis

Objective:To investigate real-time three-dimensional echocardiography(RT-3DE)to evaluate left atrial volume and function in patients with cirrhosis,and to analyse the correlation between serological indicators and E/e′ and left atrial volume strain parameters in patients with cirrhosis,thus providing an important test for detecting early cardiac damage in patients with cirrhosis.Methods:1.We selected 88 patients with definite clinical diagnosis of cirrhosis in the First Affiliated Hospital of Nanchang University from September 2020 to August 2021,and grouped them according to Child-Pugh scores: 31 patients with Child-Pugh grade A(group A),32 patients with Child-Pugh grade B(group B),25 patients with Child-Pugh grade C(group C).Patients with cirrhosis were divided into compensated and decompensated stages according to the severity of their disease.Thirty healthy controls(control group)were selected at the same time.General information and blood biochemical parameters such as gender,age,height,weight,prothrombin time,international normalized ratio,albumin and total bilirubin were recorded for all patients.2.All cirrhotic patients and healthy controls underwent conventional 2D cardiac ultrasound,Doppler ultrasound,and 3D image acquisition.2D ultrasound measured left ventricular posterior wall thickness(LVPWT),interventricular septal thickness(IVST),left ventricular end-diastolic internal diameter(LVEDD),left ventricular endsystolic internal diameter(LVESD),left ventricular ejection fraction(LVEF),left atrial internal diameter,and left atrial volume index(LAVI).Spectral Doppler measures early mitral orifice diastolic flow velocity(E),peak early and late mitral orifice diastolic flow velocity ratio(E/A),mean of peak early diastolic mitral septal and lateral annular motion(e′),and peak early diastolic mitral flow velocity/ peak mitral annular motion ratio(E/e′).3.Left atrial volume parameters measured real-time 3D ultrasound technology:left atrial minimum volume(LA Vmin),left atrial maximum volume(LA Vmax),left atrial presystolic volume(LA Vpre A),left atrial evacuation volume(LA EV),left atrial evacuation fraction(LA EF);left atrial strain parameters: storage strain(LASr and LASr-c),ductal strain(LAScd and LAScd-c),systolic strain(LASct and LASct-c).4.Statistical analysis was performed to determine whether the differences between groups A,B and C and the control group were statistically significant,and to analysis the correlation between serological parameters and E/e′ and left atrial parameters in the cirrhotic group.Further comparison of the differences in left atrial volume and strain parameters between the two groups in the compensated and decompensated stages of cirrhosis,and binary logistic regression analysis of the parameters with differences to determine independent predictors of the decompens-ated stage of cirrhosis.Results:1.The differences were not statistically significant(P >0.05)when comparing LVPWT,IVST,LVEDD,LVESD,LVEF,LAD and LAVI between the four groups,and LAD and LAVI between groups A,B and C.Compared with the control group,LAD and LAVI increased,E,E/A,mean e’ decreased and E/e′ increased in all cirrhosis groups,and the differences were statistically significant(P <0.05).E,E/A,e′ further decreased and E/e′ further increased in group C compared with groups A and B,with statistically significant differences(P <0.05).2.The differences in LAEF,LAScd and LASr-c were not statistically significant among the four groups(P >0.05).LA Vmin,LA Vmax,LA Vpre A and LA EV were all increased in groups A,B and C compared with the control group,and further increased with the increase in the degree of cirrhosis,and the differences were statistically significant(P <0.05).Compared with the control group,LASr decreased in all cirrhotic groups compared with the control group,LASct and LASct-c decreased and LAScd-c increased in groups B and C.The difference was statistically significant(P <0.05).LASr and LASct were lower in the decompensated stage of cirrhosis than in the compensated patients,and the difference was statistically significant(P <0.05).3.An increase in LA Vmax(OR: 1.919)was a risk factor for the severity of cirrhosis.an increase in LASr(OR: 0.749)was a protective factor for the severity of cirrhosis.4.LA Vmin,LA Vmax and LA Vpre A were positively correlated with E/e′,Prothrombin time,International Normalized Ratio,Total Bilirubin(P <0.01)and negatively correlated with albumin(P <0.01)in patients with cirrhosis.Conclusion:1.Conventional two-dimensional parameters can detect cardiac changes in patients with cirrhosis,but do not identify cardiac changes in patients with varying degrees of cirrhosis,suggesting that more systematic cardiac investigations may be considered in patients with decompensated cirrhosis whose conventional echocardiography is unremarkable at rest.2.Real-time 3D ultrasound technology allows early detection of changes in left atrial volume and strain in patients with different degrees of cirrhosis,and LA Vmax increases the risk factor for cirrhosis severity,while LASr increases the protective factor for cirrhosis severity.LA Vmin was the factor most strongly correlated with E/e′,which provides important evidence for future clinical early detection of left atrial volume and functional impairment in patients with cirrhosis.