Portopulmonary hypertension echocardiography or ultrasound: Difference between revisions
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#. Mean [[pulmonary artery pressure]]—MPAP > 25 mmHg at rest | #. Mean [[pulmonary artery pressure]]—MPAP > 25 mmHg at rest | ||
#. [[Pulmonary vascular resistance]]—PVR > 240 dynes s cm−5 | #. [[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. | #. Pulmonary artery occlusion pressure— PAOP < 15mmHg or transpulmonary gradient—TPG > 12 mmHg where TPG = MPAP − PAOP. | ||
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, | 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, with a sensitivity of 100% and a [[specificity]] as high as 96%.<ref name=Kim> The negative predictive value of this method is 100% but the [[positive predictive value]] is 60%. | ||
==References== | ==References== | ||
Revision as of 18:02, 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.
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, with a sensitivity of 100% and a specificity as high as 96%.<ref name=Kim> The negative predictive value of this method is 100% but the positive predictive value is 60%.