Assessing the left atrial function via echocardiography to detect cirrhotic cardiomyopathy in patients with liver cirrhosis - a scoping review

Abstract

Cirrhotic cardiomyopathy (CCM) is a condition observed in patients with chronic liver disease, characterized by dysfunction in both cardiac diastolic and/or systolic function. This condition is often underdiagnosed due to a lack of awareness and the possibility of misdiagnosis. Consequently, there is limited data regarding subclinical CCM in individuals with end-stage liver disease. Furthermore, there is currently no established cardiac biomarker to assess cardiovascular risk and outcomes in patients with liver cirrhosis. To address this issue, we conducted a scoping review to map the existing evidence and identify research gaps in echocardiographic assessment of left atrial (LA) function for detecting CCM in patients with liver cirrhosis. We systematically searched the Scopus, PubMed, and Web of Science databases using Population, Concept, and Context framework. The population is adult patients with liver cirrhosis. The concept is to assess LA function via echocardiography. Context is to detect CCM. We identified 364 articles, of which 24 were eligible for full-text review. Ultimately, 20 articles were included in the final analysis. Our dataset revealed various cardiovascular manifestations involving LA. Key findings related to CCM included LA enlargement and increased LA diameter and volume, which correlated with the Child-Turcotte-Pugh and Model for End-Stage Liver Disease scores. Additionally, we observed a reduction in LA strain. LA diameter, volume, and LA strain were associated with outcome prediction. Evaluating LA function with advanced echocardiographic techniques offers a promising approach for early detection and prognostic assessment of CCM. To translate these findings into standardized clinical practice, bridging existing evidence gaps with well-designed studies is crucial.