The presence of portopulmonary hypertension may preclude patients from receiving a transjugular intrahepatic portosystemic shunt or liver transplantation as a definitive treatment for end stage cirrhosis.
However, the prevalence of portopulmonary hypertension in patients with cirrhosis and refractory ascites was previously unknown.
A study by a team of Canadian Doctors published in Gut has now determined the prevalence of portopulmonary hypertension in patients with cirrhosis.
The research team also investigated possible etiological and predictive factors for portopulmonary hypertension.
62 patients with biopsy proven cirrhosis and refractory ascites underwent angiographic measurements of pulmonary and splanchnic haemodynamics.
Endothelin 1 levels were measured from the pulmonary artery.
10 patients (16.1%) fulfilled the criteria for portopulmonary hypertension with a mean pulmonary artery pressure over 25 mmHg and a pulmonary vascular resistance of at least 120 dynxs/cm<²>.
These patients had significantly higher mean right atrial pressure than patients without portopulmonary hypertension (15.4 v 7.9 mmHg). Right ventricular pressure was also significantly higher (24.7 v 14.7 mmHg).
A right atrial pressure of 14 mmHg had an 83% positive predictive value for the presence of portopulmonary hypertension.
Endothelin 1 levels were a mean of 3.04 pg/ml in patients with portopulmonary hypertension compared to 1.98 pg/ml in patients with normal portopulmonary blood pressure.
The research team suggest that the raised circulatory endothelin 1 levels are a possible cause of portopulmonary hypertension in patients with cirrhosis and ascites.
| An elevated right atrial pressure of 14 mmHg predicts the presence of portopulmonary hypertension.|