Evaluation of pulmonary arterial stiffness and comparison with right ventricular functions in patients with cirrhosis preparing for liver transplantation

Abstract

Objective: Pulmonary complications are common in patients with liver cirrhosis.Devolopment of pulmonary hypertension (PH) is associated with a poor prognosis in these patients. Pulmonary arterial stiffness (PAS) is considered an early sign of pulmonary vascular remodeling. The aim of this study is to investigate PAS and compare it with right ventricular (RV) functions in patients with cirrhosis who are scheduled for liver transplantation. Methods:The study included 52 cirrhosis patients (mean age 51.01 ± 12.18 years, male gender 76.9%) who were prepared for liver transplantation and 59 age and sex matched (mean age 51.28 ± 13.63 years, male gender 62.7%) healthy individuals.Patients with left ventricular ejection fraction (LVEF) less than 55%, ischemic heart disease, more than mild valvular heart disease, chronic pulmonary disease, congenital heart disease, rheumatic disease, moderate to high echocardiographic PH probability, rhythm or conduction disorders on electrocardiography were excluded from the study. In addition to conventional echocardiographic parameters, PAS value, pulmonary vascular resistance (PVR) and RV ejection efficiency was calculated by the related formulas with transthoracic echocardiography (TTE).Results: Demographic characteristics and cardiovascular risk factors of the groups were similar. PAS, PVR, and sPAP values were found to be significantly higher in the

Possible use of pulmonary artery stiffness in screening for portopulmonary hypertension

“…In this issue of the Journal of Clinical Ultrasound Elçioğlu et al evaluate whether echocardiographic measurement of pulmonary artery stiffness (PAS) is elevated in cirrhosis patients and whether it is correlated with RV function 5 . Consecutive cirrhosis patients undergoing liver transplantation ( n = 52) and age and sex matched healthy controls ( n = 59) underwent transthoracic echocardiography.…”

“…With regards to the pulmonary artery, a measure of stiffness should be included (RV outflow tract acceleration time <105 ms), in addition to an early diastolic pulmonary regurgitation velocity >2.2 mm/s and pulmonary artery diameter >25 mm. PAS as evaluated in the study by Elçioğlu et al may provide additional information as it not only incorporates acceleration time, but also maximal flow velocity 5 . Another reason it may have clinical relevance is that in group 1 PH patients (not POPH), PAS measured on cardiac magnetic resonance was associated with mortality 8 .…”

“…PAS as evaluated in the study by Elçioğlu et al may provide additional information as it not only incorporates acceleration time, but also maximal flow velocity. 5 Another reason it may have clinical relevance is that in group 1 PH patients (not POPH), PAS measured on cardiac magnetic resonance was associated with mortality. 8 So far, no screening algorithm to calculate the risk of PH has been incorporated in the guidelines.…”