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Characteristic haemodynamic changes of cirrhosis may influence the diagnosis of portopulmonary hypertension

Authors

  • Teresa Chiva,

    1. Liver Unit Digestive Disease Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
    2. Centro de Investigación Biomédica de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
    3. Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
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    • Both authors have equally contributed to this study and share the first authorship.
  • Cristina Ripoll,

    1. Liver Unit Digestive Disease Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
    2. Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
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    • Both authors have equally contributed to this study and share the first authorship.
  • Fernando Sarnago,

    1. Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
    2. Cardiac haemodynamic Lab, Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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  • Diego Rincón,

    1. Liver Unit Digestive Disease Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
    2. Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
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  • Judith Gómez-Camarero,

    1. Liver Unit Digestive Disease Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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  • Evelyn Galindo,

    1. Centro de Investigación Biomédica de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
    2. Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
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  • María-Vega Catalina,

    1. Liver Unit Digestive Disease Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
    2. Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
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  • Jaime Elizaga,

    1. Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
    2. Cardiac haemodynamic Lab, Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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  • Rafael Bañares

    Corresponding author
    1. Liver Unit Digestive Disease Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
    2. Centro de Investigación Biomédica de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
    3. Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
    4. Facultad de Medicina, Universidad Complutense, Madrid, Spain
    • Correspondence

      Rafael Bañares, Liver Unit Digestive Disease Department, Hospital General Universitario Gregorio Marañón, CIBEREHD, IISGM, Dr Esquerdo 46; Madrid (28007), Spain

      Tel: (+34) 915868699

      Fax: (+34) 915868018

      e-mail: rbanares@telefonica.net

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Abstract

Background & Aims

Diagnosis of portopulmonary hypertension (POPH) is based on the presence of portal hypertension and the same haemodynamic criteria as pulmonary arterial hypertension (PAH). However, the typical hyperdynamic circulation of cirrhosis may have some impact on the diagnosis of POPH. The aim was to compare the haemodynamic pattern of the pulmonary circulation between cirrhotics and non-cirrhotics, including patients with PAH.

Patients and Methods

600 patients with cirrhosis [male 77.5%, age 54 (47–60) years, Child A: 14.7%, B: 54.3%, C: 31%] received right heart catheterization. For comparison, 118 non-cirrhotic patients [male 60%, age 64 (53–65) years] with right heart catheterization and PCWP <20 mmHg were included. Both were divided into 3 groups, A: absence of pulmonary arterial hypertension; B or intermediate group: MPAP >25 mmHg, PVR 120–240 dyn s cm−5 and PCWP <15 mmHg (or PCWP >15 mmHg with TPG ≥12 mmHg); C: pulmonary arterial hypertension (same criteria as B except PVR ≥240 dyn s cm−5).

Results

Distribution of patients with cirrhosis was A 583, B 7 and C 10. Prevalence of POPH was 1.7%. Cirrhotics had lower SVR and greater CO than non-cirrhotics (P < 0.05). Interestingly, patients with cirrhosis without PAH (groups A and B) had lower PVR (P < 0.05) when comparing with non-cirrhotics, while no differences in PVR were observed in group C. However, mean TPG was greater in group C of cirrhotics [36.6 mmHg (12.2) vs. 27.1 mmHg (10.1); P = 0.034].

Conclusions

Patients with cirrhosis have lower PVR. TPG is greater in POPH than PAH. Characteristic haemodynamic changes of cirrhosis may influence the diagnosis of POPH.

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