Role of echocardiography in detecting portopulmonary hypertension in liver transplant candidates

Abstract

Portopulmonary hypertension (PPHTN) is a recognized complication of end-stage liver disease that adversely affects the outcome of orthotopic liver transplantation (OLT). There are limited data on the role of Doppler echocardiography in assessing pulmonary artery systolic pressure (PASP) in this population. The purpose of our study was to examine the accuracy of Doppler echocardiography in evaluating pulmonary artery pressures in liver transplant candidates. Clinical and demographic data were gathered retrospectively for 78 liver transplant candidates (48 men and 30 women, mean age 51 ؎ 9.6 yr) who had PASP determined both by right heart catheterization (RHC) and echocardiography. Paired sample t-test was used to compare mean PASP by echocardiography and RHC. Correlation of PASP between echocardiography and RHC was determined using Pearson's linear correlation. P ortopulmonary hypertension (PPHTN) is a recognized complication of end-stage liver disease that adversely affects the outcome of orthotopic liver transplant (OLT). The prevalence of PPHTN varies from 0.61% to 4% 1,2 in patients with cirrhosis; however, the prevalence in patients referred for OLT may be as high as 8.5%. 3,4 The wide variability in prevalence is partly attributable to varying definitions of PPHTN.Direct measurement of pulmonary artery pressure by right-heart catheterization (RHC) remains the gold standard for detecting pulmonary hypertension. However, Doppler echocardiography using transtricuspid valve gradient allows noninvasive estimation of pulmonary artery systolic pressure (PASP). [5][6][7][8][9] Although small studies have been conducted previously regarding echocardiography and the noninvasive estimation of PASP, the question of accuracy of this test in estimating pulmonary artery pressures still remains unanswered. In the setting of liver transplant patients, there is limited data comparing the usefulness of echocardiography in the assessment of PPHTN. The purpose of our study was to examine the accuracy of Doppler echocardiography in evaluating pulmonary artery pressures in liver transplant candidates. MethodsWe retrospectively reviewed the medical records of all patients enrolled in the Liver Center who were undergoing evaluation for OLT at the University of Illinois at Chicago Medical Center between 1995 and 2002. One hundred eighty-seven patients were referred for cardiac workup before liver transplantation. Of these, 15 patients did not have any workup done because of failure to show up for the appointment. The remaining 172 patients underwent echocardiograms; however, PASP could not be determined in 32 of these patients because of suboptimal windows. Twenty-two of the remaining 140 patients had a normal PASP (PASP Ͻ 30 mm Hg with no right ventricle [RV] enlargement or failure) and did not undergo RHC. Thus, these patients were excluded from analysis. Forty patients did not undergo RHC despite meeting criteria for abnormal PASP (PASP Ͼ 30 mm Hg or RV failure or enlargement) because of the following reasons: 29 patients were no...

Portopulmonary hypertension: Results from a 10-year screening algorithm

“…In that regard, our data are similar to findings from Cotton et al 11 It would appear that in both studies, as well as in our previous analysis, the discordance between RVSP and catheterization results worsens as the screening echo-derived RVSP increases. 10 *Hemodynamic parameter differences within high-flow and POPH subgroups (P Ͻ .001).…”

“…The risk in proceeding to liver transplantation in such patients would not appear to be increased from a pulmonary hemodynamic perspective as supported by previous reports. 1,11,13 Catheterization allowed calculation of a transpulmonary gradient (MPAP-PAOP). Importance of the transpulmonary gradient relates to the scenario in which increased pulmonary venous pressure (measured via PAOP) may exist in addition to and further worsen an increased MPAP.…”

“…2,8 POPH is now recognized as a unique entity within the modified World Health Organization Group I category of pulmonary arterial hypertension. 9 Noninvasive screening for POPH using Doppler echocardiography in liver transplantation candidates has been proposed, [10][11][12] but reports of echocardiography-right heart catheterization relationships are few with limited interpretation of right heart catheterization results. 1,10,11,13,14 We report the results of our prospective screening echocardiography-right heart catheterization algorithm conducted in consecutive liver transplantation candidates at the Mayo Clinic from 1996 to 2005.…”

Letter: cardiovascular complications in patients with transjugular intrahepatic portosystemic shunt – the necessity for regular cardiac surveillance. Authors' reply

“…5 PASP measured during echocardiography allows a first assessment of pulmonary hypertension and showed a weak correlation with pulmonary artery pressure measured on right heart catheterization in liver transplant candidates. 6 Sensitivity for detection of portopulmonary hypertension, in a further study, was 80% and specificity was 91% at a cut-off ≥40 mmHg. 7 It was also found to independently correlate with length of intensive care unit and hospital stay as well as with time on ventilator after liver transplantation.…”

“…4 Therefore, the majority of PUB patients died of nonbleeding-related causes. 6 ACKNOWLEDGEMENT Declaration of personal and funding interests: None.…”