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Echocardiography for the detection of portopulmonary hypertension in liver transplant candidates: An analysis of cutoff values
Author(s) -
Raevens Sarah,
Colle Isabelle,
Reyntjens Koen,
Geerts Anja,
Berrevoet Frederik,
Rogiers Xavier,
Troisi Roberto I.,
Vlierberghe Hans,
Pauw Michel
Publication year - 2013
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.23649
Subject(s) - portopulmonary hypertension , medicine , cutoff , liver transplantation , contraindication , asymptomatic , portal hypertension , pulmonary artery , cardiology , pulmonary hypertension , cardiac catheterization , heart transplantation , transplantation , cirrhosis , pathology , physics , alternative medicine , quantum mechanics
Portopulmonary hypertension (POPH), a complication of chronic liver disease, may be a contraindication to liver transplantation (LT) because of the elevated risk of peritransplant and posttransplant morbidity and mortality. Because POPH is frequently asymptomatic, screening with echocardiography is recommended. The only reliable technique, however, for diagnosing POPH is right heart catheterization (RHC). The aims of this study were to evaluate the current estimated systolic pulmonary artery pressure (sPAP) cutoff value of 30 mm Hg and to determine a better cutoff value. One hundred fifty‐two patients underwent pretransplant echocardiography between January 2005 and December 2010. These echocardiographic results were compared with pulmonary artery pressures measured during the pretransplant workup or at the beginning of the transplantation procedure (both by catheterization). With a cutoff value of 30 mm Hg, 74 of the 152 patients met the criteria for POPH on echocardiography, although the diagnosis was confirmed in only 7 patients during catheterization; this resulted in a specificity of 54%. It would have been more accurate to use a cutoff value of 38 mm Hg, which had a maximal specificity of 82% and, at the same time, guaranteed a sensitivity and negative predictive value of 100%. With the incorporation of the presence or absence of right ventricular dilatation, the specificity even increased to 93% for this new cutoff value. In conclusion, the prevalence of POPH was 4.6% among LT candidates in this study. We can recommend that LT candidates with an sPAP > 38 mm Hg should be referred for RHC. With the cutoff value increased from 30 to 38 mm Hg, the number of patients undergoing invasive RHC during their evaluation could be safely reduced. Liver Transpl 19:602–610, 2013 . © 2013 AASLD.