Document Detail

Prediction of intrapulmonary right to left shunt with left atrial size in patients with liver cirrhosis.
MedLine Citation:
PMID:  17140853     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: We screened a large number of liver transplant candidates with contrast echocardiography to detect intrapulmonary right to left shunt (IPS). We found that IPS is frequently present in patients with left atrial enlargement. This finding raises a question concerning the correlation between IPS and left atrial size in patients with liver cirrhosis. OBJECTIVES: The aim of this prospective study was to evaluate the possible correlation between left atrial size and IPS in patients with liver cirrhosis. METHODS: Adult patients (>18 years old) with documented liver cirrhosis underwent trans-thoracic contrast echocardiography with agitated saline. Left atrial dimension was measured by M-mode echocardiography. Stroke volume was calculated using left ventricular M-mode echocardiography. Patients with atrial fibrillation, intracardiac shunt, congenital heart defects, valvular heart disease and diastolic dysfunction were excluded. RESULTS: A total of 92 patients met all study criteria. Of these, 39 (42.3%) had IPS. Cardiac output was significantly greater in patients with IPS compared with those without IPS (5.68 +/- 0.83 L/min vs 4.75 +/- 0.76 L/min, P < 0.01). In a multi-variable model, after adjustment for body surface area and body mass index, left atrial enlargement was the strong predictor of IPS (area under the curve = 0.66) but when controlling for cardiac output, left atrial size was not an independent predictor of IPS. CONCLUSION: In the context of liver cirrhosis, patients with IPS have greater cardiac output compared with those without shunt. Left atrial enlargement, which reflects one aspect of increased cardiac output, is an indirect marker of IPS and greater left atrial dimension is associated with the presence of intrapulmonary right-to-left shunt.
Mahmood Zamirian; Amir Aslani; Mohamad Bagher Sharifkazemi
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology     Volume:  9     ISSN:  1532-2114     ISO Abbreviation:  Eur J Echocardiogr     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-02-12     Completed Date:  2008-06-03     Revised Date:  2008-07-29    
Medline Journal Info:
Nlm Unique ID:  100890618     Medline TA:  Eur J Echocardiogr     Country:  England    
Other Details:
Languages:  eng     Pagination:  1-4     Citation Subset:  IM    
Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran.
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MeSH Terms
Cardiac Output
Chi-Square Distribution
Contrast Media
Heart Atria / physiopathology*,  ultrasonography*
Hepatopulmonary Syndrome / physiopathology*,  ultrasonography*
Liver Cirrhosis / complications*,  surgery
Liver Transplantation
Middle Aged
Predictive Value of Tests
Prospective Studies
ROC Curve
Reg. No./Substance:
0/Contrast Media

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