Echocardiography as a Screening Modality for Portopulmonary Hypertension in Patients with Cirrhosis and Chronic Viral Hepatitis

Abstract

Objective: To assess porto pulmonary hypertension by echocardiography in patients with cirrhosis and chronic viral hepatitis. Study Design: Comparative cross-sectional study. Place and Duration of Study: Gastroenterology and Cardiology Departments Combined Military Hospital, Multan Pakistan, from Mar to Dec 2020. Methodology: Fifty patients with cirrhosis due to chronic hepatitis C, B/D, with Child-Turcotte-Pugh score>6, Model for End Stage Liver Disease–Sodium score>9, were compared to a Control-Group of 50 patients with chronic liver disease due to chronic hepatitis C, B/D; for the frequency of portopulmonary hypertension in the former group. In addition to pulmonary artery pressures, tricuspid regurgitation, right ventricle to left ventricle base ratio, and right ventricle tricuspid annular plane systolic excursion were also assessed. Results: Four patients (8%) with cirrhosis (irrespective of severity) had porto pulmonay hypertension, and none in the Control-Group. The median pulmonary artery pressure in the Patient-Group was 20 mmHg (15-46), and in the Control-Group was 17 mm Hg (15-20). The Child Turcotte Pugh, Model for End Stage Liver Disease–Sodium parameters, pulmonary artery pressure and tricuspid annular plane systolic excursion were deranged in the Patient-Group and showed statistical significance. The area under the ROC curve for pulmonary artery pressure in the Patient-Group was 0.803. Conclusion: In patients with cirrhosis, 8% had portopulmonary hypertension. Echocardiography is an important screening method for the assessment of portopulmonary hypertension in this patient population.

Keywords

• Chronic viral hepatitis
• Cirrhosis
• echocardiography
• Porto pulmonary hypertension
• Right ventricle tricuspid annular plane systolic excursion