Author + information
- Sun M. Kim,
- Michael Faulkner,
- David Booth,
- Charles Campbell,
- Jonathan Hundley,
- Richard Charnigo and
- Alison Bailey
Portopulmonary hypertension (POPH) is defined as a mean pulmonary artery pressure (mPAP) > 25 mm Hg, pulmonary capillary wedge pressure (PCWP) ≤ 15 mm Hg and pulmonary vascular resistance (PVR) > 3 Wood units with portal hypertension. It is present in about 10% of patients referred for liver transplant. Severe POPH (mPAP ≥ 50mmHg) is associated with 100% post-transplant mortality whereas an increase in mortality is not seen when mPAP < 35mmhg. Treatment exists for POPH, with responders having similar outcomes as other transplant recipients. Thus, recognizing POPH is of increasing importance. Guidelines note the uncertainties of noninvasive assessment for POPH and suggest pulmonary artery systolic pressure (PASP) >45 mmHg as a threshold value for invasive assessment “until more data are available”.
We retrospectively evaluated Doppler echocardiograms and invasive hemodynamic data on 137 liver transplant candidates and aimed to determine the PASP value that would exclude significant POPH. Receiver-operating characteristic curve analysis was performed to identify this PASP value.
Of the 137 patients, 105 had both an interpretable PASP and invasive hemodynamic assessment. Of these, 14 (13%) had a mPAP >35. Three of the14 patients met classic criteria for POPH. However, 5 of 14 patients were felt to have POPH with a PCWP > 15 mmHg, suggesting a mixed disorder with mild volume overload. The remaining 6 patients were felt to have the syndrome of cirrhosis-related volume overload characterized by an elevated mPAP, high cardiac output and thus a normal PVR. Identification of all patients with mPAP >35 mmHg required invasive assessment for a threshold value of PASP ≥37 mmHg. Using this threshold value, the sensitivity of detecting a mPAP >35 mmHg was 100%, with a specificity of 9% and positive predictive value of 14%. An area under the curve of 0.726 was obtained.
Identification of all patients with mPAP >35 mmHg by noninvasive measures is possible, but requires a substantial number of invasive procedures be performed. Additional studies are warranted that focus on improved detection of POPH with noninvasive methods.
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Pulmonary Hypertension: Epidemiology, Prognosis, Outcomes
Abstract Category: 27. Pulmonary Hypertension
Presentation Number: 1251M-153
- 2013 American College of Cardiology Foundation