Prognostic Implications of Cardiac Geometry in Cirrhosis: Findings From a Large Cohort

BACKGROUND AND AIMS: Cirrhosis is characterised by hyperdynamic circulation, which contributes to cirrhotic cardiomyopathy (CCM). However, the expert consensus on CCM did not initially include cardiac structure because of scant evidence. Therefore, this study investigated the associations of cardiac chamber geometry with mortality and CCM. METHODS: We retrospectively included 2514 cirrhotic patients from 2011 to 2023. In accordance with the guidelines for echocardiography, left ventricular (LV) hypertrophy (LVH) and LV, left atrial (LA), right ventricular (RV), and right atrial (RA) enlargement were evaluated. Cox and logistic regression analyses were performed to examine the relationships among cardiac chamber, all-cause mortality, and CCM. RESULTS: The prevalence rates of LV hypertrophy and LV, LA, RV, and RA enlargement were 21.9%, 21.3%, 30.4%, 5.9%, and 10.9%, respectively. Concentric LVH (HR: 1.305, 95% confidence interval (CI): 1.153-1.466), eccentric LVH (HR: 1.272, 95% CI: 1.139-1.426), LV enlargement (HR: 1.305, 95% CI: 1.153-1.466), and LA enlargement (HR: 1.254, 95% CI: 1.130-1.379) were significantly associated with mortality during the median follow-up of 2.1 years. In a subcohort of 1898 individuals, CCM, with a prevalence of 29.0%, was independently associated with concentric LVH (OR: 1.834, 95% CI: 1.214-2.707), eccentric LVH (OR: 3.063, 95% CI: 2.379-3.903), LV enlargement (OR: 2.519, 95% CI: 2.150-2.977), LA enlargement (OR: 3.559, 95% CI: 2.770-4.321), and RA enlargement (OR: 1.416, 95% CI: 1.025-1.915). LV abnormalities showed 90% specificity and 35% sensitivity for CCM diagnosis. CONCLUSIONS: Geometric pattern changes in the LV and LA are prevalent and independently associated with all-cause mortality and CCM. These indicators have potential for hazard stratification and CCM redefinition.