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Correlation between Echocardiographic Pulmonary Artery Pressure Estimates and Right Heart Catheterization Measurement in Liver Transplant Candidates

  • Habash, Fuad (Department of Cardiology, University of Arkansas for Medical Sciences) ;
  • Gurram, Pooja (Department of Cardiology, University of Arkansas for Medical Sciences) ;
  • Almomani, Ahmed (Department of Cardiology, University of Arkansas for Medical Sciences) ;
  • Duarte, Andres (Department of Cardiology, University of Arkansas for Medical Sciences) ;
  • Hakeem, Abdul (Department of Cardiology, University of Arkansas for Medical Sciences) ;
  • Vallurupalli, Srikanth (Department of Cardiology, University of Arkansas for Medical Sciences) ;
  • Bhatti, Sabha (Department of Cardiology, University of Arkansas for Medical Sciences)
  • 투고 : 2018.02.19
  • 심사 : 2018.04.13
  • 발행 : 2018.06.27

초록

BACKGROUND: Patients undergoing liver transplant have worse outcomes in the presence of pulmonary hypertension. Correlation between echocardiography and catheterization derived pressures in this population is not well studied. Our study's aim is to show the relationship between pulmonary artery systolic pressure derived from transthoracic echo (ePASP) with pulmonary artery systolic pressure measured during right heart catheterization (cPASP). METHODS: Single center retrospective study, patients being evaluated for liver transplant (n = 31) who had an interpretable Doppler signal for ePASP and had right heart catheterization (RHC) measurements within 3 months constituted the study group. Control group (n = 49) consisted of patients who did not have liver disease. RESULTS: There was modest correlation between ePASP and cPASP (R = 0.58, p < 0.001) in LT candidates (n = 31) compared with the control group (R = 0.74, p < 0.001, n = 49). The 95% limits of agreement by Bland-Altman analysis ranged from +33.6 mmHg to -21.7 mmHg. Using receiver operating characteristic analysis, ePASP cut-off > 47 mmHg was 59% sensitive and 78% specific to diagnose pulmonary artery (PA) hypertension (mean PA pressure > 25 mmHg) in the LT candidates, while a similar cutoff performed well in the control group (cutoff > 43 mmHg, n = 47, 91% sensitive, 100% specific). CONCLUSIONS: Compared with other disease states, ePASP correlates modestly with cPASP in patients with advanced liver disease. A higher ePASP cutoff should be used to screen for pulmonary hypertension. A multi-center prospective study with simultaneous transthoracic echocardiography and RHC measurements is required to determine the best cut-off in this population.

키워드

참고문헌

  1. Galie N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J 2015;46:903-75. https://doi.org/10.1183/13993003.01032-2015
  2. Kia L, Shah SJ, Wang E, et al. Role of pretransplant echocardiographic evaluation in predicting outcomes following liver transplantation. Am J Transplant 2013;13:2395-401. https://doi.org/10.1111/ajt.12385
  3. Krowka MJ, Mandell MS, Ramsay MA, et al. Hepatopulmonary syndrome and portopulmonary hypertension: a report of the multicenter liver transplant database. Liver Transpl 2004;10:174-82. https://doi.org/10.1002/lt.20016
  4. Rodriguez-Roisin R, Krowka MJ, Herve P, Fallon MBERS Task Force Pulmonary-Hepatic Vascular Disorders (PHD) Scientific Committee. Pulmonary-Hepatic vascular Disorders (PHD). Eur Respir J 2004;24:861-80. https://doi.org/10.1183/09031936.04.00010904
  5. Hoeper MM, Lee SH, Voswinckel R, et al. Complications of right heart catheterization procedures in patients with pulmonary hypertension in experienced centers. J Am Coll Cardiol 2006;48:2546-52. https://doi.org/10.1016/j.jacc.2006.07.061
  6. Steckelberg RC, Tseng AS, Nishimura R, Ommen S, Sorajja P. Derivation of mean pulmonary artery pressure from noninvasive parameters. J Am Soc Echocardiogr 2013;26:464-8. https://doi.org/10.1016/j.echo.2013.01.006
  7. Hua R, Sun YW, Wu ZY, et al. Role of 2-dimensional Doppler echo-cardiography in screening portopulmonary hypertension in portal hypertension patients. Hepatobiliary Pancreat Dis Int 2009;8:157-61.
  8. Cotton CL, Gandhi S, Vaitkus PT, et al. Role of echocardiography in detecting portopulmonary hypertension in liver transplant candidates. Liver Transpl 2002;8:1051-4. https://doi.org/10.1053/jlts.2002.35554
  9. Torregrosa M, Genesca J, Gonzalez A, et al. Role of Doppler echocardiography in the assessment of portopulmonary hypertension in liver transplantation candidates. Transplantation 2001;71:572-4. https://doi.org/10.1097/00007890-200102270-00015
  10. Currie PJ, Seward JB, Chan KL, et al. Continuous wave Doppler determination of right ventricular pressure: a simultaneous Doppler-catheterization study in 127 patients. J Am Coll Cardiol 1985;6:750-6. https://doi.org/10.1016/S0735-1097(85)80477-0
  11. Chan KL, Currie PJ, Seward JB, Hagler DJ, Mair DD, Tajik AJ. Comparison of three Doppler ultrasound methods in the prediction of pulmonary artery pressure. J Am Coll Cardiol 1987;9:549-54. https://doi.org/10.1016/S0735-1097(87)80047-5
  12. Yock PG, Popp RL. Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation 1984;70:657-62. https://doi.org/10.1161/01.CIR.70.4.657
  13. Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010;23:685-713; quiz 786-8. https://doi.org/10.1016/j.echo.2010.05.010
  14. Chemla D, Castelain V, Humbert M, et al. New formula for predicting mean pulmonary artery pressure using systolic pulmonary artery pressure. Chest 2004;126:1313-7. https://doi.org/10.1378/chest.126.4.1313
  15. Krowka MJ, Miller DP, Barst RJ, et al. Portopulmonary hypertension: a report from the US-based REVEAL Registry. Chest 2012;141:906-15. https://doi.org/10.1378/chest.11-0160
  16. Herve P, Lebrec D, Brenot F, et al. Pulmonary vascular disorders in portal hypertension. Eur Respir J 1998;11:1153-66. https://doi.org/10.1183/09031936.98.11051153
  17. Salgia RJ, Goodrich NP, Simpson H, Merion RM, Sharma P. Outcomes of liver transplantation for porto-pulmonary hypertension in model for end-stage liver disease era. Dig Dis Sci 2014;59:1976-82. https://doi.org/10.1007/s10620-014-3065-y
  18. Bozbas SS, Bozbas H. Portopulmonary hypertension in liver transplant candidates. World J Gastroenterol 2016;22:2024-9. https://doi.org/10.3748/wjg.v22.i6.2024
  19. Swanson KL, Wiesner RH, Nyberg SL, Rosen CB, Krowka MJ. Survival in portopulmonary hypertension: Mayo Clinic experience categorized by treatment subgroups. Am J Transplant 2008;8:2445-53. https://doi.org/10.1111/j.1600-6143.2008.02384.x
  20. Bozbas SS, Eyuboglu FO, Arslan NG, Ergur FO, Karakayali H, Haberal M. The prevalence and the impact of portopulmonary hypertension on postoperative course in patients undergoing liver transplantation. Transplant Proc 2009;41:2860-3. https://doi.org/10.1016/j.transproceed.2009.06.178
  21. Krowka MJ, Plevak DJ, Findlay JY, Rosen CB, Wiesner RH, Krom RA. Pulmonary hemodynamics and perioperative cardiopulmonary-related mortality in patients with portopulmonary hypertension undergoing liver transplantation. Liver Transpl 2000;6:443-50. https://doi.org/10.1053/jlts.2000.6356
  22. Raevens S, Colle I, Reyntjens K, et al. Echocardiography for the detection of portopulmonary hypertension in liver transplant candidates: an analysis of cutoff values. Liver Transpl 2013;19:602-10. https://doi.org/10.1002/lt.23649
  23. Kim WR, Krowka MJ, Plevak DJ, et al. Accuracy of Doppler echocardiography in the assessment of pulmonary hypertension in liver transplant candidates. Liver Transpl 2000;6:453-8. https://doi.org/10.1053/jlts.2000.7573
  24. Colle IO, Moreau R, Godinho E, et al. Diagnosis of portopulmonary hypertension in candidates for liver transplantation: a prospective study. Hepatology 2003;37:401-9. https://doi.org/10.1053/jhep.2003.50060
  25. Finkelhor RS, Lewis SA, Pillai D. Limitations and strengths of Doppler/echo pulmonary artery systolic pressure-right heart catheterization correlations: a systematic literature review. Echocardiography 2015;32:10-8. https://doi.org/10.1111/echo.12594
  26. Farber HW, Foreman AJ, Miller DP, McGoon MD. REVEAL Registry: correlation of right heart catheterization and echocardiography in patients with pulmonary arterial hypertension. Congest Heart Fail 2011;17:56-64. https://doi.org/10.1111/j.1751-7133.2010.00202.x
  27. Testani JM, St John Sutton MG, Wiegers SE, Khera AV, Shannon RP, Kirkpatrick JN. Accuracy of noninvasively determined pulmonary artery systolic pressure. Am J Cardiol 2010;105:1192-7. https://doi.org/10.1016/j.amjcard.2009.11.048

피인용 문헌

  1. Intraoperative anesthetic management of the liver transplant recipient with portopulmonary hypertension vol.24, pp.2, 2018, https://doi.org/10.1097/mot.0000000000000613
  2. Noninvasive estimation of pulmonary vascular resistance improves portopulmonary hypertension screening in liver transplant candidates vol.33, pp.7, 2018, https://doi.org/10.1111/ctr.13585
  3. Role of echocardiography in screening for portopulmonary hypertension in liver transplant candidates: a meta-analysis vol.8, pp.None, 2020, https://doi.org/10.7717/peerj.9243
  4. Performance of echocardiography for detection of portopulmonary hypertension among liver transplant candidates: Meta‐analysis vol.34, pp.11, 2020, https://doi.org/10.1111/ctr.13995