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Pulmonary Vascular Disease |

Prevalence and Implications of Positive Contrast Transthoracic Echocardiography in Portopulmonary Hypertension

Lynn Fussner, MD; Vivek Iyer, MD; Rodrigo Cartin-Ceba, MD; Michael Krowka, MD
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Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN


Chest. 2013;144(4_MeetingAbstracts):855A. doi:10.1378/chest.1702024
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Abstract

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

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