Pulmonary blood transit time and impaired arterial oxygenation in patients with chronic liver disease.
BACKGROUND
Contrast-enhanced echocardiography (CEE) using agitated saline can detect intrapulmonary vasodilatation (IPVD) in patients with hepatopulmonary syndrome (HPS). We estimated the pulmonary transit time of erythrocytes (PTT) by CEE, using microbubbles, and studied its relationship to arterial oxygenation in chronic liver disease.


METHODS
Sixteen patients with chronic liver disease and seven healthy subjects were studied. PTT was defined as the time between opacification of the right atrium and left atrium on CEE, using human serum albumin-air microbubble complexes with a mean diameter of 4 microm (Albunex). IPVD was detected by CEE with agitated saline. Arterial blood gases were analyzed with patients in the supine position, and while they were seated. Cardiac output (CO) was determined by Doppler echocardiography.


RESULTS
The mean PTT value for all of the patients was 4.0 +/- 1.4 s. One of the 3 patients who showed IPVD was normoxemic. Mild orthodeoxia was observed in the patients with abnormal alveolar-arterial oxygen difference (A-aDO2) values (>15 mmHg), but not in those with normal A-aDO2 values, or in the healthy subjects. PTT was correlated with PaO2 (r = 0.52; P < 0.05; n = 16) and A-aDO2 (r = -0.54; P < 0.05; n = 16) in the seated position. CO was significantly correlated with PTT (r = -0.62; P < 0.05; n = 15), but not with PaO2 and A-aDO2, in both positions.


CONCLUSIONS
PTT may be a useful parameter for evaluating arterial oxygenation in patients with chronic liver disease with early HPS.
Katsuta
Yasumi
Y
First Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
Honma
Hiroshi
H
Zhang
Xue-Jun
XJ
Ohsuga
Masaru
M
Komeichi
Hirokazu
H
Shimizu
Shuji
S
Katoh
Yoshihito
Y
Miura
Hiroshi
H
Satomura
Katsuaki
K
Aramaki
Takumi
T
Takano
Teruo
T
D000328:Adult; D000368:Aged; D000472:Alkalosis, Respiratory / Q000000981:diagnostic imaging / Q000378:metabolism / Q000503:physiopathology; D001784:Blood Gas Analysis; D002302:Cardiac Output / Q000502:physiology; D002908:Chronic Disease; D004452:Echocardiography; D004912:Erythrocytes / Q000000981:diagnostic imaging / Q000378:metabolism; D005260:Female; D020065:Hepatopulmonary Syndrome / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000503:physiopathology*; D006801:Humans; D016857:Hypocapnia / Q000000981:diagnostic imaging / Q000378:metabolism / Q000503:physiopathology; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000503:physiopathology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism*; D011187:Posture / Q000502:physiology; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000503:physiopathology*; D011652:Pulmonary Circulation / Q000502:physiology*; D013997:Time Factors; D014664:Vasodilation / Q000502:physiology
D010100:Oxygen