Prevalence and characteristics of portopulmonary hypertension in cirrhotic patients who underwent both hepatic vein and pulmonary artery catheterization

Masanori Atsukawa; Akihito Tsubota; Masaru Hatano; Chisa Kondo; Kaori Shioda; Hiroki Ohno; Tadamichi Kawano; Korenobu Hayama; Taeang Arai; Ai Nakagawa-Iwashita; Norio Itokawa; Keiko Kaneko; Yuji Yoshida; Mai Koeda; Tomomi Okubo; Teppei Yamamoto; Takeshi Yamamoto; Nobuhiko Taniai; Hiroshi Yoshida; Hidenori Kanazawa; Wataru Shimizu; Katsuhiko Iwakiri

doi:10.1111/hepr.13560

Prevalence and characteristics of portopulmonary hypertension in cirrhotic patients who underwent both hepatic vein and pulmonary artery catheterization

Hepatol Res. 2020 Nov;50(11):1244-1254. doi: 10.1111/hepr.13560. Epub 2020 Sep 1.

Authors

Masanori Atsukawa¹, Akihito Tsubota², Masaru Hatano³, Chisa Kondo¹, Kaori Shioda¹, Hiroki Ohno¹, Tadamichi Kawano¹, Korenobu Hayama¹, Taeang Arai¹, Ai Nakagawa-Iwashita¹, Norio Itokawa¹, Keiko Kaneko¹, Yuji Yoshida⁴, Mai Koeda⁴, Tomomi Okubo⁴, Teppei Yamamoto⁴, Takeshi Yamamoto⁵, Nobuhiko Taniai⁶, Hiroshi Yoshida⁶, Hidenori Kanazawa¹, Wataru Shimizu⁵, Katsuhiko Iwakiri¹

Affiliations

¹ Division of Gastroenterology and Hepatology, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan.
² Core Research Facilities, The Jikei University School of Medicine, 3-9-18, Nishishinbashi, Minato-ku, Tokyo, Japan.
³ Department of therapeutic strategy for heart failure, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan.
⁴ Division of Gastroenterology, Nippon Medical School Chiba Hokusoh Hospital, 1715, kamakari, Inzai, Chiba, Japan.
⁵ Division of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan.
⁶ Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan.

PMID: 32822521
DOI: 10.1111/hepr.13560

Abstract

Portopulmonary hypertension (PoPH) is a well-known complication of liver cirrhosis. The aim of this study was to clarify the pulmonary hemodynamics and the prevalence and characteristics of PoPH in patients with portal hypertension.

Methods: The subjects were 335 patients with portal hypertension diagnosed by hepatic vein pressure gradient (HVPG). Among them, 186 patients received measurements of pulmonary artery pressure (PAP), pulmonary artery wedge pressure (PAWP) and pulmonary vascular resistance (PVR). PoPH was diagnosed by PAP >20 mmHg, PVR ≥3 Wood units (WU) and PAWP ≤15 mmHg.

Results: The Child-Pugh classification was class A in 53, B in 92 and C in 41 patients. Median (range) values of HVPG, PAP, PVR and PAWP were 18.4 (5.5-39.0) mmHg, 12.9 (6.6-40.8) mmHg, 0.8 (0.1-4.5) WU and 7.5 (2.2-15.4) mmHg, respectively. Of six patients with PAP >20 mmHg, four had autoimmune hepatitis or primary biliary cholangitis, with the prevalence being significantly higher than that in patients with PAP ≤20 mmHg. Meanwhile, no significant difference was noted in the hepatic functional reserve or HVPG between patients with PAP >20 mmHg and ≤20 mmHg. Only two patients met the diagnostic criteria of PoPH and both patients were Child-Pugh B. The Child-Pugh score and HVPG were not associated with PoPH.

Conclusions: Our study demonstrated that only two patients were complicated by PoPH. High PAP values were noted in patients with primary biliary cholangitis or autoimmune hepatitis. However, the presence of PoPH and high PAP were not associated with the degree of hepatic functional reserve or HVPG.

Keywords: liver cirrhosis; portal hypertension; portopulmonary hypertension; pulmonary artery pressure; pulmonary vascular resistance.