Portopulmonary hypertension: Improved detection using CT and echocardiography in combination

Devaraj, Anand; Loveridge, Robert; Bosanac, Diana; Stefanidis, Konstantinos; Bernal, William; Willars, Christopher; Wendon, Julia; Auzinger, G.

doi:10.1007/s00330-014-3289-4

Cited by 21 publications

(12 citation statements)

References 32 publications

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“…Without applying a gold standard to echocardiographic results that is more reliable than regurgitant velocity measurements, such as pulmonary artery catheterization, the sensitivity and specificity of echocardiographic determination of pulmonary hypertension is unknown as is the true prevalence of pulmonary hypertension in dogs. In multiple human studies, CT‐derived MPA:Ao either outperformed echocardiographic determination of the presence of pulmonary hypertension with a cutoff value for MPA:Ao being well established to distinguish cases of pulmonary hypertension from normal, or improved detection of pulmonary hypertension when used in combination with echocardiography …”

Section: Discussionmentioning

confidence: 99%

“…Estimates of pulmonary arterial pressure provided by echocardiographic Doppler interrogation of tricuspid and pulmonic regurgitant jets allow less invasive diagnosis of pulmonary hypertension in dogs . However, regurgitant jets are not always present, measurement is dependent on breed conformation and operator skill, and difficulty obtaining maximal velocities is common . Additionally, a threshold of velocities defining pulmonary hypertension is not well established .…”

Section: Introductionmentioning

confidence: 99%

“…Ratios of the main pulmonary artery to aortic diameter have been reported in humans via CT . In humans, an increase in the diameter of the MPA measured by CT is strongly predictive of pulmonary hypertension when compared to direct pulmonary arterial pressure measurements and use of a cutoff value for MPA diameter has been established that selects for cases of even mild pulmonary hypertension .…”

Section: Introductionmentioning

confidence: 99%

“…In humans with chronic obstructive pulmonary disease, where disease exacerbation potentially leading to accelerated loss of lung function and death is anticipated with presence of severe pulmonary hypertension, the MPA:Ao threshold of 1 is a sensitive index predicting the severity of disease exacerbation . A recent publication in humans having portopulmonary hypertension has shown that the detection of pulmonary hypertension was improved using a combination of CT measurement of the MPA:Ao and echocardiographic estimation of pulmonary arterial pressure rather than echocardiography alone . In another recent study, the correlation of the MPA:Ao and mean pulmonary arterial pressure as measured by pulmonary artery catheterization was significantly stronger than the echocardiographically derived estimation of mean pulmonary arterial pressure in humans with chronic obstructive pulmonary disease .…”

Section: Introductionmentioning

confidence: 99%

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Computed Tomographic Measurement of the Main Pulmonary Artery to Aortic Diameter Ratio in Healthy Dogs: A Comparison to Echocardiographically Derived Ratios

Granger¹,

Pariaut²,

Vila³

et al. 2016

Vet Radiology Ultrasound

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Indicators of pulmonary hypertension in dogs examined with thoracic computed tomography (CT) are not well established in the veterinary literature. In humans, the main pulmonary artery to aortic diameter ratio (MPA:Ao) measured via CT, has been shown to be more sensitive than echocardiographic variables for predicting presence and severity of pulmonary hypertension, in some cases. In veterinary literature, the MPA:Ao has been determined echocardiographically to have an upper limit of about 1:1. Measurement of this ratio has not been described in dogs using CT. The objectives of this cross-sectional, prospective study were to compare echocardiographic measurement of MPA:Ao with that obtained via CT, determine if measurement of MPA:Ao via CT is repeatable and reproducible, and determine the effect of respiration and contrast administration on the measurement of MPA:Ao via CT. Ten healthy dogs without pulmonary hypertension were anesthetized to undergo thoracic CT using three protocols and echocardiography. The MPA:Ao was measured three times by three observers for each of the three CT protocols and compared to echocardiographic measurements. The mean MPA:Ao measured among all observers and CT protocols was 1.108 ± 0.152 (SD). The effect of CT scan protocol on MPA:Ao significantly differed among the three methods (P = 0.0014), where expiratory scans had lower MPA:Ao than inspiratory scans. The ratio measured on inspiratory CT scans consistently overestimated MPA:Ao when compared to echocardiography (bias = 0.226). Findings did not support the echocardiographically derived upper limit of MPA:Ao as an upper limit for determination of main pulmonary arterial enlargement on CT.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Computed Tomographic Measurement of the Main Pulmonary Artery to Aortic Diameter Ratio in Healthy Dogs: A Comparison to Echocardiographically Derived Ratios

Granger¹,

Pariaut²,

Vila³

et al. 2016

Vet Radiology Ultrasound

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“…Based on different RVSP cutoffs, others have recommended that LT candidates with an RVSP > 38 mmHg should be referred for RHC (Raevens et al 2013a). More recently, the measurement of the main pulmonary artery diameter by computed tomography combined with echocardiography improved the accuracy in the diagnosis of POPH (Devaraj et al 2014). …”

Section: Screening For Pophmentioning

confidence: 98%

Hepatopulmonary Syndrome and Portopulmonary Hypertension

Cartin‐Ceba¹,

Iyer²,

Krowka³

2014

Contemporary Liver Transplantation

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Hepatopulmonary syndrome (HPS) and portopulmonary hypertension (POPH) are pulmonary vascular complications of portal hypertension with or without cirrhosis. The prevalence among liver transplant candidates is roughly 5-32 % for HPS and approximately 6 % for POPH. Although these two conditions may initially present with dyspnea and are pathologically linked by the presence of portal hypertension, their pathophysiologic mechanisms are significantly different. HPS is characterized by low pulmonary vascular resistance secondary to intrapulmonary vascular dilatations and hypoxemia; on the other hand, POPH features elevated pulmonary vascular resistance and constriction of the pulmonary vasculature. Medical treatment for HPS has been disappointing overall. POPH patients can be treated with pulmonary artery-specific vasodilatory therapy. Whereas liver transplantation (LT) results in the resolution of HPS and is an indication per se for LT, its effect on POPH is highly unpredictable. LT poses a high risk of death in those with significant POPH, where pulmonary artery-specific vasodilatory therapy may improve functional status and allow successful LT in a small number of select patients. Modern strategies in managing HPS and POPH rely on a thorough screening and grading of the disease's severity, in order to tailor the appropriate therapy and select only the patients who will benefit from LT.

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Liver Transplantation as a Challenge for the Anesthesiologist: Preoperative Cardiac Assessment to Orient the Perioperative Period

Gasperi

Biancofiore

Mazza

et al. 2020

Liver Transplantation and Hepatobiliary Surgery

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Portopulmonary hypertension: Improved detection using CT and echocardiography in combination

Abstract: • CT signs correlate with right-sided heart catheter data in portopulmonary hypertension • CT adds to the transthoracic echocardiography detection of portopulmonary hypertension • CT may have a complementary role in pre-liver transplantation triage.

Cited by 21 publications

References 32 publications

Computed Tomographic Measurement of the Main Pulmonary Artery to Aortic Diameter Ratio in Healthy Dogs: A Comparison to Echocardiographically Derived Ratios

Computed Tomographic Measurement of the Main Pulmonary Artery to Aortic Diameter Ratio in Healthy Dogs: A Comparison to Echocardiographically Derived Ratios

Hepatopulmonary Syndrome and Portopulmonary Hypertension

Liver Transplantation as a Challenge for the Anesthesiologist: Preoperative Cardiac Assessment to Orient the Perioperative Period

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