Semiquantitative echocardiographic evaluation of intrapulmonary vascular dilatations: correlation with evaluation of shunt levels and pulmonary function parameters.
OBJECTIVE
To correlate semiquantitative evaluation of intrapulmonary vascular dilatations (IPVD) with quantitative evaluation of shunt levels, as well as to describe clinical and pulmonary function findings in a sample of liver disease patients with IPVD.


METHODS
Patients presenting transthoracic echocardiography (TTE) positivity for IPVD underwent clinical evaluation, pulmonary function tests and pulmonary shunt quantification (scintigraphy with technetium-99m-labeled albumin macroaggregates and blood gas analysis after pure oxygen breathing).


RESULTS
A total of 28 liver cirrhosis patients were studied (mean age, 47.5 years; 60.7% were Child-Pugh class B). A 4-point, ascending scale was used as a measure of IPVD intensity, which was scored as 1, 2, 3 and 4, respectively, in 13 (46.4%), 9 (32.1%), 2 (7.1%) and 4 (14.3%) of the patients. Patients were divided into a low-intensity group (scores 1 and 2) and a high-intensity group (scores 3 and 4). The mean shunt assessed using scintigraphy was 14.9% in the sample as a whole and was lower in the low-intensity group (11.7% vs. 26.3%; p = 0.01). The mean shunt by blood gas analysis was higher in the high-intensity group (8.3% vs. 16.3%; p < 0.001). Mean PaO2 was lower in the high-intensity group. There was a negative correlation between DLCO and IPVD severity (r = -0.406, p = 0.01).


CONCLUSIONS
TTE is a safe, useful tool for assessing IPVD severity in liver disease patients. The IPVD intensity assessed using TTE correlated with the intrapulmonary shunt values obtained through the quantitative methods evaluated, as well as with pulmonary gas exchange abnormalities.
Ferreira
Maria Angélica Pires
MA
Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil. mpiferreira@hcpa.ufrgs.br
Barreto
Sérgio Saldanha Menna
SS
Knorst
Marli Maria
MM
Silva
Mario Reis Alvares da
MR
Pinotti
Antonio Furlan
AF
D000328:Adult; D001784:Blood Gas Analysis; D004452:Echocardiography; D005260:Female; D020065:Hepatopulmonary Syndrome / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008103:Liver Cirrhosis / Q000503:physiopathology; D008107:Liver Diseases / Q000503:physiopathology*; D016031:Liver Transplantation; D008168:Lung / Q000098:blood supply* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D018579:Patient Selection; D011659:Pulmonary Gas Exchange; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D013668:Technetium Tc 99m Aggregated Albumin; D014664:Vasodilation; D055815:Young Adult
D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D010100:Oxygen