Prevalence and characteristics of portopulmonary hypertension in cirrhotic patients who underwent both hepatic vein and pulmonary artery catheterization

Abstract

Portopulmonary hypertension (PoPH) is a well-known complication of liver cirrhosis. The aim of this study was to clarify the pulmonary hemodynamics and the prevalence and characteristics of PoPH in patients with portal hypertension. Methods: The subjects were 335 patients with portal hypertension diagnosed by hepatic vein pressure gradient (HVPG). Among them, 186 patients received measurements of pulmonary artery pressure (PAP), pulmonary artery wedge pressure (PAWP) and pulmonary vascular resistance (PVR). PoPH was diagnosed by PAP >20 mmHg, PVR ≥3 Wood units (WU) and PAWP ≤15 mmHg. Results: The Child-Pugh classification was class A in 53, B in 92 and C in 41 patients. Median (range) values of HVPG, PAP, PVR and PAWP were 18.4 (5.5-39.0) mmHg, 12.9 (6.6-40.8) mmHg, 0.8 (0.1-4.5) WU and 7.5 (2.2-15.4) mmHg, respectively. Of six patients with PAP >20 mmHg, four had autoimmune hepatitis or primary biliary cholangitis, with the prevalence being significantly higher than that in patients with PAP ≤20 mmHg. Meanwhile, no significant difference was noted in the hepatic functional reserve or HVPG between patients with PAP >20 mmHg and ≤20 mmHg. Only two patients met the diagnostic criteria of PoPH and both patients were Child-Pugh B. The Child-Pugh score and HVPG were not associated with PoPH. Conclusions: Our study demonstrated that only two patients were complicated by PoPH. High PAP values were noted in patients with primary biliary cholangitis or autoimmune hepatitis. However, the presence of PoPH and high PAP were not associated with the degree of hepatic functional reserve or HVPG.

Prevalence and Associated Factors of Portopulmonary Hypertension in Patients with Portal Hypertension: A Case-Control Study

“…Our study found that there were no differences in liver function, Child-Pugh classification, MELD score, or etiology between the POPH group and the non-POPH group. This is consistent with the results of a previous study that the Child-Pugh classification is not related to POPH [ 18 ]. Studies have shown that increased MELD scores in POPH patients before transplantation are associated with poor survival after transplantation [ 19 ], and we need to confirm this conclusion with long-term follow-up observation.…”

Gastroesophageal varices evaluation using spleen‐dedicated stiffness measurement by vibration‐controlled transient elastography

“…Portopulmonary hypertension (PoPH) is a severe complication of CLD. 35,36 PoPH is also a devastating complication of portal hypertension. 37,38 PoPH has a very poor prognosis; therefore, useful noninvasive tests for PoPH are needed.…”

Screening for portopulmonary hypertension using computed tomography‐based measurements of the main pulmonary artery and ascending aorta diameters in patients with portal hypertension

“…[27][28][29][30] Concerning higher IVC-SD, it is generally recommended to esti- With regards to presence of PSSs, some studies showed a strong association between the development of spontaneous PSSs and onset of PoPH as in our results, 32,33 yet others did not find a correlation. 25 However, recently increased levels of vasoconstrictors such as serotonin and endothelin-1, produced in the splanchnic circulation, not metabolized by the liver, and reaching the pulmonary circulation via PSSs have been proposed as the mechanism responsible for the development of PoPH in cirrhosis. 6,34 In addition, PAP is increased as a result of increased pulmonary blood flow through PSSs as well as increased vasoactive substance-mediated pulmonary vascular resistance.…”