Cotton Cynthia L, Gandhi Sanjay, Vaitkus Paul T, Massad Malek G, Benedetti Enrico, Mrtek Robert G, Wiley Thelma E
Department of Digestive and Liver Diseases, University of Illinois at Chicago, Chicago, IL, USA.
Liver Transpl. 2002 Nov;8(11):1051-4. doi: 10.1053/jlts.2002.35554.
Portopulmonary hypertension (PPHTN) is a recognized complication of end-stage liver disease that adversely affects the outcome of orthotopic liver transplantation (OLT). There are limited data on the role of Doppler echocardiography in assessing pulmonary artery systolic pressure (PASP) in this population. The purpose of our study was to examine the accuracy of Doppler echocardiography in evaluating pulmonary artery pressures in liver transplant candidates. Clinical and demographic data were gathered retrospectively for 78 liver transplant candidates (48 men and 30 women, mean age 51 +/- 9.6 yr) who had PASP determined both by right heart catheterization (RHC) and echocardiography. Paired sample t-test was used to compare mean PASP by echocardiography and RHC. Correlation of PASP between echocardiography and RHC was determined using Pearson's linear correlation. Positive and negative predictive values for echocardiography for PASP > 50 mmHg are reported as compared with RHC. The mean PASP by echocardiography (43.2 +/- 12.3 mm Hg) was significantly higher than mean PASP by RHC (33.7 +/- 15.5 mm Hg; P <.001). Regarding PASP, there was a significant but weak correlation between echocardiography and RHC (r = 0.46, P =.01). The positive and negative predictive values of echocardiography for identifying clinically significant pulmonary hypertension (PASP > 50 mm Hg) were 37.5% and 91.9%, respectively. Echocardiography is a useful tool in estimating PASP in liver transplant candidates. Patients with apparently elevated PASP by echocardiography should undergo invasive assessment by RHC before being excluded from liver transplant.
肝肺综合征（PPHTN）是终末期肝病公认的并发症，会对原位肝移植（OLT）的预后产生不利影响。关于多普勒超声心动图在评估该人群肺动脉收缩压（PASP）中的作用的数据有限。我们研究的目的是检验多普勒超声心动图在评估肝移植候选者肺动脉压力方面的准确性。回顾性收集了78例肝移植候选者（48例男性和30例女性，平均年龄51±9.6岁）的临床和人口统计学数据，这些患者的PASP通过右心导管检查（RHC）和超声心动图测定。采用配对样本t检验比较超声心动图和RHC测得的平均PASP。使用Pearson线性相关性确定超声心动图和RHC之间PASP的相关性。报告了与RHC相比，超声心动图对PASP>50 mmHg的阳性和阴性预测值。超声心动图测得的平均PASP（43.2±12.3 mmHg）显著高于RHC测得的平均PASP（33.7±15.5 mmHg；P<.001）。关于PASP，超声心动图和RHC之间存在显著但较弱的相关性（r = 0.46，P =.01）。超声心动图识别临床显著肺动脉高压（PASP>50 mmHg）的阳性和阴性预测值分别为37.5%和91.9%。超声心动图是评估肝移植候选者PASP的有用工具。超声心动图显示PASP明显升高的患者在被排除肝移植之前应接受RHC的有创评估。
