Risk factors for portopulmonary hypertension in patients with cirrhosis: a prospective, multicenter study

Abstract

Background Measurement of the tricuspid regurgitation pressure gradient (TRPG) by echocardiography is recommended as the most objective examination for the detection of portopulmonary hypertension (PoPH). This prospective study aimed to identify factors associated with a high TRPG in patients with cirrhosis and develop a screening method for identifying patients most likely to bene t from investigation with echocardiography.Results Four hundreds and eighty-six patients with cirrhosis underwent Doppler echocardiography, and were analyzed in the present study. Of the 486 patients, 51 (10.5%) had TRPG ≥35 mmHg. The median BNP was 39.5 (range, 3.3-712.0) pg/mL. Ninety-one (18.7%) patients reported shortness of breath.Multivariate analysis identi ed female, shortness of breath, and BNP ≥49 pg/mL as independent factors for TRPG ≥35 mmHg. The risk score for predicting TRPG ≥35 mmHg was calculated: risk score = −3.230 + 0.622 × gender (female: 1, male: 0) + 1.403 × shortness of breath (presence: 1, absence: 0) + 0.726 × BNP (≥ 49pg/mL: 1, <49 pg/mL: 0). An optimal cut-off risk score for predicting TRPG ≥35 mmHg was −1.882 (AUC, 0.731; sensitivity, 68.6%; speci city, 70.6%). The prevalence of TRPG ≥35 mmHg in patients with a risk score ≥−1.882 (21.5%) was signi cantly higher than that in patients with a risk score <−1.882(5.0%) (p = 7.02 × 10 −8 ).Conclusions We clari ed the characteristics of patients with suspected PoPH, and developed a scoring model for identifying patients at high risk of PoPH, which may have utility in selecting patients with cirrhosis that may bene t from echocardiography.

How do the 2022 European Society of Cardiology/European Respiratory Society guidelines modify the diagnosis of portopulmonary hypertension in patients with cirrhosis complicated by portal hypertension? A post hoc analysis

“…According to a previous study, 5 the cut‐off mPAP value of 25 mmHg on right heart catheterization corresponds approximately to the cut‐off TRPG value of 35 mmHg on echocardiography. We have reported that TRPG ≥35 mmHg is associated with female sex, shortness of breath, and brain natriuretic peptide (BNP) ≥48.9 pg/mL and suggested that patients with these factors should undergo echocardiography 6 . However, this cut‐off TRPG value needs to be re‐established with the publication of the 2022 ESC/ERS criteria.…”

“…We have reported that TRPG ≥35 mmHg is associated with female sex, shortness of breath, and brain natriuretic peptide (BNP) ≥48.9 pg/mL and suggested that patients with these factors should undergo echocardiography. 6 However, this cut‐off TRPG value needs to be re‐established with the publication of the 2022 ESC/ERS criteria.…”

Is pulmonary arterial hypertension associated with schistosomiasis distinct from pulmonary arterial hypertension associated with portal hypertension?

“…Biochemical studies indicate the synthetic dysfunction is more severe among those with PoPAH than those with SchHSD. 7 , 19 , 20 However, hepatocellular injury severity is not associated with the development of PoPAH ( Table 1 ) and, more specifically, the Model for End-Stage Liver Disease score does not correlate with the incidence of PoPAH. 7 , 21 Furthermore, PoPAH can complicate liver diseases that have relatively little hepatocellular dysfunction.…”