Assessment of Left Atrial Dysfunction Using Speckle Tracking Echocardiography in Patients Awaiting Liver Transplant

Introduction

Pre-transplant cardiac evaluation is crucial for identifying patients at risk of peri- and post-operative cardiovascular complications. Advanced echocardiography, particularly left atrial strain (LAS) analysis, offers a sensitive assessment of atrial function, which is not always detectable with conventional echocardiographic parameters. The aim of this study is to evaluate the clinical utility of advanced echocardiographic values, such as left atrial strain, in risk stratification and understanding cardiac pathophysiology in patients undergoing orthotopic liver transplant (OLT).

Methods

A retrospective observational study was conducted, including 41 consecutive patients awaiting OLT. The patient cohort had a mean age of 58 ± 10 years, with 14.6% being female. Regarding the etiology of liver disease, 36.6% had viral etiology, 29.3% had MASLD, and 39.0% had alcohol-related cirrhosis. 48.8% (20 patients) had HCC as an OLT indication. The median MELD score was 16 (IQR: 12), and the median MELD-Na score was 17 (IQR: 14). All patients underwent comprehensive echocardiographic evaluation, including assessment of left atrial longitudinal strain parameters using Speckle Tracking Echocardiography: LA-Strain Reservoir (LASr) 35.8% ± 10.3 (normal value >39%), LA-Strain Conduit (LAScd) 19.6% ± 7.3 (normal value 15-25%), and LA-Strain Contractile (LASct) 16.5 ± 6.9 (normal value 17-19%). Follow-up data were also recorded during the first month post-transplant.

Results

Correlation analyses revealed significant relationships between left atrial strain and the severity of liver disease. In particular, LASct showed a strong, statistically significant negative correlation with the MELD score at the time of OLT evaluation (r = -0.832, p = 0.010) and with the Na-MELD score (r = -0.850, p = 0.008). These results indicate that higher MELD scores are associated with significant deterioration of left atrial contractile function. During the follow-up period, 4 patients (9.8%) developed early cardiovascular events (<1 month post-OLT): 1 case of Tako-tsubo, 1 sudden cardiac death, 1 atrial fibrillation, and 1 acute myocardial infarction. In the comparative analysis between patients with events and those without events, LASr showed a statistically significant difference (p = 0.023) compared to patients without events.

Conclusions

These data suggest that LASct, an indicator of left atrial contractility, is closely correlated with the severity of advanced liver disease. Furthermore, LASr, an indicator of left atrial distensibility and filling, could be an early risk indicator for specific cardiovascular complications in this type of patient, thus having a prognostic role.