Hemodynamic and Clinical Determinants of Left Atrial Enlargement in Liver Transplant Candidates.

New-onset heart failure is a frequent complication after orthotopic liver transplantation (OLT). Left atrial enlargement (LAE) may be a sign of occult left heart disease. Our primary objective was to determine invasive hemodynamic and clinical predictors of LAE and then investigate its effect on post-transplant outcomes. Of 609 subjects who received OLT between January 1, 2010, and October 1, 2018, 145 who underwent preoperative right-sided cardiac catheterization and transthoracic echocardiography were included. Seventy-eight subjects (54%) had pretransplant LAE. Those with LAE had significantly lower systemic vascular resistance with higher cardiac and stroke volume index (61.0 vs 51.7 ml/m2; p <0.001), but there was no difference in pulmonary artery wedge pressure. There was a linear relation between left atrial volume index and stroke volume index (R2 = 0.490, p<0.001), but not pulmonary artery wedge pressure. The presence of severe LAE was associated with a reduced likelihood (hazard ratio = 0.26, p = 0.033) of reaching the composite end point of new-onset systolic heart failure, heart failure hospitalization, or heart failure death within 12 months post-transplant. There was also a significant reduction in LAE after transplantation (p = 0.013). In conclusion, LAE was common in OLT recipients and was more closely associated with stroke volume than left heart filling pressures. The presence of LAE was associated with a reduced likelihood of reaching composite outcomes and tended to regress after transplant.

Errors in Reporting Significant Figures in Surgical and Medical Journals in 2017.

BACKGROUND: The present study was undertaken to ascertain the prevalence of published data with errors in the numerical significant figures in established surgical and medical journals in 2017. The frequency of errors was not only summarized but was also correlated to the published journal impact factor for the seven journals reviewed. METHODS: All original investigations and other analysis reporting quantitative statistical results published in seven surgical and medical journals in 2017 were electronically reviewed for errors in reporting significant figures of the published statistical findings. Errors in significant figures were placed into one of three author defined categories: calculated significant figure errors, interval precision errors, and P value reporting errors. Tests for intraobserver and interobserver reproducibility were conducted blindly to ensure validity and reproducibility between different readers. RESULTS: A total of 1675 articles published in 2017 were identified and reviewed. In total, 730 articles (44%) were reported to have an error in one category, with error rates ranging from 25% to 68% depending on publishing journal. The error rate for each journal were easily reproduced by different observers (κ coefficient range: 0.55-0.81) and correlated with its 2016 impact factor (r = 0.97, R2 = 0.95, P < 0.001). CONCLUSIONS: Published findings are frequently reported incorrectly in the surgical and medical literature and can be potentially misleading. The pervasiveness of errors correlates to fewer citations as measured by the lower impact factor.