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

Background. Portopulmonary hypertension is a severe complication of liver c irrhosis that carries a high risk for posttransplantation mortality. We aim ed at evaluating the utility of Doppler echocardiography in screening for p ortopulmonary hypertension in liver transplantation candidates. Methods, One hundred seven cirrhotic patients candidates for liver transpla ntation were studied by Doppler echocardiography and subsequently, by cardi ac catheterization at transplantation. Two parameters were estimated by Dop pler: systolic pulmonary arterial pressure (SPAP) derived from tricuspid re gurgitation and the pulmonary acceleration time. Portpulmonary hypertension was suspected when SPAP was greater than or equal to 40 mm Hg and/or pulmo nary acceleration time <100 ms. Results. Portpulmonary hypertension was suspected by Doppler study in 17 pa tients (15%), However, portopulmonary hypertension (mean pulmonary arterial pressure <greater than or equal to>25 mm Hg and pulmonary vascular resista nce >120 dynes.s/cm(5)) was confirmed by the hemodynamic study in five pati ents (4.7%), Sensitivity and specificity of Doppler echocardiography for de tecting portopulmonary hypertension was 100 and 88%, respectively, with a p ositive predictive value of 30%, The diagnostic accuracy of pulmonary accel eration 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 portopulmonar y hypertension in patients with liver cirrhosis who are candidates for live r transplantation.