Bi-atrial structural and mechanical remodelling in cirrhosis: an echocardiographic strain-based phenotyping study

Background Cirrhosis is associated with a hyperdynamic circulatory state and chronic volume overload, which may lead to cardiac remodeling before overt ventricular dysfunction becomes evident. Conventional echocardiographic assessment relies largely on atrial size, potentially underestimating early atrial mechanical dysfunction. Objectives To evaluate left and right atrial structural and mechanical remodeling in patients with cirrhosis using echocardiography and atrial strain imaging, and to assess their relationship with liver disease severity. Methods In this cross-sectional study, patients with cirrhosis and age- and sex-matched healthy controls underwent comprehensive transthoracic echocardiography. Left atrial volume index and right atrial area index were measured using standard techniques. Left and right atrial reservoir strain were assessed using two-dimensional speckle-tracking echocardiography. Associations between atrial parameters and MELD-Na score were analyzed. Results Cirrhotic patients demonstrated significant impairment in both left and right atrial reservoir strain compared with controls, despite only modest differences in atrial size. A substantial proportion of patients exhibited preserved atrial dimensions with impaired atrial strain, indicating early mechanical dysfunction. Progressive deterioration in bi-atrial strain was observed across increasing MELD-Na categories. Conclusions Cirrhosis is associated with early bi-atrial mechanical dysfunction detectable by strain imaging, preceding overt atrial enlargement and conventional diastolic abnormalities. Atrial strain provides incremental insight into cirrhotic cardiomyopathy and may serve as a useful tool for early cardiovascular phenotyping in chronic liver disease.