Role of Doppler echocardiography in the assessment of portopulmonary hypertension in liver transplantation candidates

Background. Portopulmonary hypertension is a severe complication of liver cirrhosis that carries a high risk for posttransplantation mortality. We aimed at evaluating the utility of Doppler echocardiography in screening for portopulmonary hypertension in liver transplantation candidates. Methods, One hundred seven cirrhotic patients candidates for liver transplantation were studied by Doppler echocardiography and subsequently, by cardiac catheterization at transplantation. Two parameters were estimated by Doppler: systolic pulmonary arterial pressure (SPAP) derived from tricuspid regurgitation and the pulmonary acceleration time. Portpulmonary hypertension was suspected when SPAP was greater than or equal to 40 mm Hg and/or pulmonary acceleration time <100 ms. Results. Portpulmonary hypertension was suspected by Doppler study in 17 patients (15%), However, portopulmonary hypertension (mean pulmonary arterial pressure 25 mm Hg and pulmonary vascular resistance >120 dynes.s/cm(5)) was confirmed by the hemodynamic study in five patients (4.7%), Sensitivity and specificity of Doppler echocardiography for detecting portopulmonary hypertension was 100 and 88%, respectively, with a positive predictive value of 30%, The diagnostic accuracy of pulmonary acceleration time alone (96%) was better than pulmonary arterial pressure alone (90%). Conclusions. Doppler echocardiography, and especially the determination of pulmonary acceleration time, is a useful screening method for portopulmonary hypertension in patients with liver cirrhosis who are candidates for liver transplantation.