Portopulmonary hypertension echocardiography or ultrasound: Difference between revisions
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==Overview== | ==Overview== | ||
==Echocardiography== | ==Echocardiography== | ||
The diagnosis of portopulmonary hypertension is based on | The diagnosis of portopulmonary hypertension is based on hemodynamic criteria: | ||
#. | #. Portal hypertension and/or liver disease (clinical diagnosis—ascites/varices/splenomegaly) | ||
#. Mean | #. Mean pulmonary artery pressure—MPAP > 25 mmHg at rest | ||
#. | #. Pulmonary vascular resistance—PVR > 240 dynes s cm−5 | ||
#. Pulmonary artery occlusion | #. Pulmonary artery occlusion pressure— PAOP < 15mmHg or transpulmonary gradient—TPG > 12 mmHg where TPG = MPAP − PAOP.<ref name=swanson>Swanson KL et al. Survival in Portopulmonary Hypertension: Mayo Clinic Experience Categorized by Treatment Subgroups. Am J Transpl 2008; 8: 2445–2453</ref> | ||
The diagnosis is usually first suggested by a transthoracic [[echocardiogram]], part of the standard pre-transplantation work-up. Echocardiogram estimated pulmonary artery systolic pressures of 40 to 50 mm Hg are used as a screening cutoff for PPH diagnosis,<ref>Torregosa et al. Role of Doppler echos in the assessment of PPHTN in liver transplant candidates. Transplantation 2001;71:572-574</ref> with a sensitivity of 100% and a specificity as high as 96%. The negative predictive value of this method is 100% but the positive predictive value is 60%.<ref name=Colle> Colle et al. Diagnosis of portopulmonary hypertension in candidates for liver transplant: a prospective study. Hepatology 2003;37:401-209</ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 18:04, 24 September 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Echocardiography
The diagnosis of portopulmonary hypertension is based on hemodynamic criteria:
- . Portal hypertension and/or liver disease (clinical diagnosis—ascites/varices/splenomegaly)
- . Mean pulmonary artery pressure—MPAP > 25 mmHg at rest
- . Pulmonary vascular resistance—PVR > 240 dynes s cm−5
- . Pulmonary artery occlusion pressure— PAOP < 15mmHg or transpulmonary gradient—TPG > 12 mmHg where TPG = MPAP − PAOP.[1]
The diagnosis is usually first suggested by a transthoracic echocardiogram, part of the standard pre-transplantation work-up. Echocardiogram estimated pulmonary artery systolic pressures of 40 to 50 mm Hg are used as a screening cutoff for PPH diagnosis,[2] with a sensitivity of 100% and a specificity as high as 96%. The negative predictive value of this method is 100% but the positive predictive value is 60%.[3]
References
- ↑ Swanson KL et al. Survival in Portopulmonary Hypertension: Mayo Clinic Experience Categorized by Treatment Subgroups. Am J Transpl 2008; 8: 2445–2453
- ↑ Torregosa et al. Role of Doppler echos in the assessment of PPHTN in liver transplant candidates. Transplantation 2001;71:572-574
- ↑ Colle et al. Diagnosis of portopulmonary hypertension in candidates for liver transplant: a prospective study. Hepatology 2003;37:401-209