Clinical predictors of pulmonary hypertension in patients undergoing livertransplant evaluation

Clinical prediction of portopulmonary hypertension (PPHTN) is critical in t he preoperative evaluation of candidates for orthotopic liver transplantati on (OLT) because of its association with significant morbidity and mortalit y To determine the clinical, laboratory, and echocardiographic predictors o f PPHTN, we retrospectively evaluated 55 candidates before OLT. From those, 8 candidates had pulmonary hypertension ([HTN] group A) and 47 candidates did not (group B). Pulmonary HTN was defined as a mean pulmonary artery pre ssure (PAP) of 25 mm Hg or greater and either elevated pulmonary vascular r esistance or normal pulmonary artery wedge pressure. The significant predic tors of PPHTN were (I.) systemic arterial HTN (63% in group A v 9% in group B; P <.001), (2) loud pulmonary component of the second heart sound (38% v 2%; P =.001), (3) right ventricular (RV) heave (38% v 4%; P =.002), (4) RV dilatation by echocardiogram (63% v 0%; P <.001), (5) RV hypertrophy by ec hocardiogram (38% v 0%; P =.001), and (6) echocardiogram-estimated systolic PAP (SPAP) greater than 40 mm Hg (63% v 2%; P <.001). The sensitivity of t hese variables for the detection of pulmonary HTN ranges from 37% to 63%, a nd their specificity from 91% to 100%. We conclude that several clinical an d echocardiographic features are significantly associated with pulmonary HT N in patients with cirrhosis. In particular, echocardiogram-estimated SPAP greater than 40 mm Hg is strongly associated with pulmonary HTN and is spec ific. These predictors, however, are not sensitive enough to identify all t he patients with PPHTN. Therefore, the evaluation of a combination of these variables may be useful for the preoperative identification of pulmonary H TN in liver transplant candidates. Copyright (C) 2000 by the American Assoc iation for the Study of Liver Diseases.