Original Contribution
The American Journal of Gastroenterology (2007) 102, 1392–1396; doi:10.1111/j.1572-0241.2007.01228.x
Left Atrial Volume: A Novel Predictor of Hepatopulmonary Syndrome
Mahmood Zamirian MD, Amir Aslani MD and Shahab Shahrzad MD
Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
Correspondence: M Zamirian, MD, P.O. Box 71935-1334, Namazee Hospital, Shiraz, Iran.
Received 30 November 2006; Accepted 14 February 2007.
Abstract
OBJECTIVES:
We studied patients with hepato-pulmonary syndrome (HPS). We found that HPS is frequently present in patients with left atrial enlargement. The aim of this prospective study was to evaluate the possible correlation between left atrial volume and HPS.
METHODS:
Adult patients (>18 yr old) with biopsy proven liver cirrhosis who were referred for liver transplantation were enrolled in the study. Diagnosis of HPS was established when the following points were fulfilled: (a) the presence of chronic liver disease, (b) increased alveolar-arterial difference (AaDO2), (c) intrapulmonary vascular dilatation, and (d) absence of primary cardiac or pulmonary disease.
RESULTS:
We enrolled 41 patients (mean age 47.1 
10.6 yr) diagnosed with HPS. Also 108 Child-Pugh score matched cirrhotic patients (mean age 49.2 9.3 yr) who have negative contrast echocardiography and normal age-related AaDO2 were selected as a control group for the purpose of comparison of left atrial volume (LAV). LAV was significantly greater in patients with HPS compared to the control group (55.1 7.5 mL vs 37.1 9.3 mL, P < 0.05). The area under the receiver-operating characteristic (ROC) curve for LAV was 0.903 (Cut point 
50 mL, sensitivity 86.3%, specificity 81.2%).
CONCLUSION:
In the context of liver cirrhosis, LAV 50 mL is a simple and feasible parameter to detect HPS.
