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Portopulmonary hypertension: Results from a 10-year screening algorithm.
Michael J Krowka1, Karen L Swanson, Robert P Frantz
1Divisions of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. krowka@mayo.edu
Hepatology (Baltimore, Md.)
|November 30, 2006
Summary
Portopulmonary hypertension (POPH) screening requires right heart catheterization for accurate diagnosis. Echocardiography may overestimate pulmonary artery pressure, necessitating catheterization to confirm POPH and identify other causes in liver transplant candidates.
Area of Science:
- Cardiology
- Hepatology
- Pulmonology
Background:
- Portopulmonary hypertension (POPH) is a serious complication of portal hypertension, associated with increased mortality in liver transplant candidates.
- Screening for POPH is recommended due to the risks associated with liver transplantation in affected patients.
Purpose of the Study:
- To evaluate the correlation between echocardiography-based screening and right heart catheterization (RHC) for diagnosing POPH.
- To characterize the hemodynamic profiles of patients with suspected POPH undergoing liver transplantation evaluation.
Main Methods:
- Prospective study (1996-2005) involving liver transplant candidates.
- Doppler echocardiography to estimate right ventricular systolic pressure (RVSP), followed by RHC for mean pulmonary artery pressure (MPAP), cardiac output (CO), pulmonary artery occlusion pressure (PAOP), and pulmonary vascular resistance (PVR) in 101 patients with RVSP >50 mm Hg.
- Bland-Altman analysis to compare echocardiography and RHC measurements.
Main Results:
- Significant discordance observed between echocardiography-derived RVSP and RHC findings.
- Pulmonary hypertension (MPAP >25 mm Hg) confirmed in 90% of patients.
- POPH (MPAP >25 mm Hg and PVR ≥240 dynes/s/cm⁻⁵) diagnosed in 65% of patients.
- 35% of patients presented with elevated MPAP due to increased CO and/or PAOP, not elevated PVR.
- Transpulmonary gradient helped characterize POPH in patients with increased volume.
Conclusions:
- Right heart catheterization is essential for accurate POPH diagnosis and differentiating it from other causes of pulmonary hypertension in liver transplant candidates.
- Echocardiography alone is insufficient for definitive POPH diagnosis.
- Hemodynamic assessment via RHC is crucial for identifying high-flow or high-volume states contributing to elevated pulmonary pressures.
- Model for End-Stage Liver Disease (MELD) scores showed poor correlation with POPH severity (MPAP and PVR).
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