Background: The presence of pulmonary hypertension (PHTN) in the setting of end stage liver disease increases mortality before and after orthotopic liver transplantation (OLT). A 2D echocardiogram (ECHO) is routinely done in most transplant centers to screen for PHTN, but the sensitivity and specificity is not well understood in this patient population.
Methods: Data from 164 OLT recipients between April 2008 and December 2011; recipients with multi-organ transplantation other than liver/kidney (n=7) were excluded. Patient who underwent right heart catheterization (RHC) and ECHO tests prior to OLT were included in this analysis (n=68).Demographic and clinical information was obtained. Statistical analysis was performed to assess sensitivity, specificity and accuracy of ECHO versus RHC. Presence of PHTN was defined as mean PA pressure over 25 mmHg on RHC.
Results: Mean patient age was 59 years (range, 46-75), 45 (66%) were male, 45 (66%) were white, and 38 (56%) had HCV. At OLT, median biological MELD was 22 (range 6-49). Eleven patients (16%) had mPAP ≥25 mmHg. Patients with PHTN had a higher BMI (32.1 vs 28.5, p=0.01), and no HCC [3 (27%) vs 34 (60%), p=0.01]. PHTN patients also had a longer post OLT ICU stay (8 days vs 3 days, p=0.003). In the diagnosis of PHTN, accuracy was only 22%, with a high sensitivity of 91% but low specificity of only 9%. Overall median follow up was 23.5 months, and one year survival in both groups was excellent (100% in patients with PHTN vs 93% in patients without PHTN, p=.037).
Conclusions: In patients undergoing evaluation for liver transplantation, echocardiogram appears to be an adequate screening test with a sensitivity of 91%. The diagnosis must be confirmed by invasive testing with right heart catheterization, as the specificity is very low at only 9%.
To cite this abstract in AMA style:Boktour M, Jhun H, Ghobrial R, Bhimaraj A, Estep J, Burroughs SGordon, Monsour H, Frenette C. Sensitivity of Screening Echocardiogram to Detected Pulmonary Hypertension in Patients with End Stage Liver Disease Undergoing Liver Transplant Evaluation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/sensitivity-of-screening-echocardiogram-to-detected-pulmonary-hypertension-in-patients-with-end-stage-liver-disease-undergoing-liver-transplant-evaluation/. Accessed May 7, 2021.
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