Pulmonary Vascular Disease |

Prevalence and Implications of Positive Contrast Transthoracic Echocardiography in Portopulmonary Hypertension FREE TO VIEW

Lynn Fussner, MD; Vivek Iyer, MD; Rodrigo Cartin-Ceba, MD; Michael Krowka, MD
Author and Funding Information

Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN

Chest. 2013;144(4_MeetingAbstracts):855A. doi:10.1378/chest.1702024
Text Size: A A A
Published online


SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Hepatopulmonary syndrome (HPS) and portopulmonary hypertension (POPH) are pulmonary complications of end-stage liver disease with divergent clinicopathologic features and management. HPS is characterized by hypoxemia due to intrapulmonary vascular dilatations and contrast transthoracic echocardiography (cTTE) is positive for intrapulmonary shunting. Alternatively, POPH is characterized by pulmonary artery hypertension due to vasoproliferation and obstruction to arterial flow. Prevalence and implications of intrapulmonary shunting in POPH are unknown. The aim of this study is to characterize a subset of POPH patients with positive cTTE and relationships to oxygenation, hemodynamics and survival.

METHODS: Retrospective chart review of 72 POPH patients diagnosed from January 2002 to December 2012. Data abstraction was performed for cTTE result, baseline characteristics, pulmonary hemodynamics, oxygenation and survival.

RESULTS: A total of 51 patients were included in the study (21 subjects excluded because no cTTE was available). A total of 36/51 (71%) had a positive cTTE. The positive cTTE group had significantly lower diffusion capacity for carbon monoxide (DLCO) at a median of 56.0% of predicted (interquartile range [IQR] 47.5-66.0) versus 80.5% of predicted (IQR 68.3-83.8; p < 0.001). Age, gender, model for end-stage liver disease (MELD) score, mean pulmonary artery pressure (MPAP), pulmonary capillary wedge pressure (PCWP), pulmonary vascular resistance (PVR), cardiac output (CO), PaO2, A-a gradient, and survival were similar between the groups (p > 0.05).

CONCLUSIONS: A substantial proportion of POPH patients have evidence of intrapulmonary shunting. This is associated with a lower DLCO on pulmonary function testing as compared to POPH without shunt, while MPAP, PCWP, PVR, CO, PaO2, A-a gradient, and survival are similar in the two groups.

CLINICAL IMPLICATIONS: Our findings suggest that positive cTTE is a frequent finding in POPH and is associated with a lower DLCO, without clear differences in oxygenation, hemodynamic parameters, or survival. Further investigation is needed to determine the extent of this relationship, and the impact of positive cTTE on liver transplant evaluation and outcomes.

DISCLOSURE: The following authors have nothing to disclose: Lynn Fussner, Vivek Iyer, Rodrigo Cartin-Ceba, Michael Krowka

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543