title: Left ventricle enlargement and increased systolic velocity in the mitral valve are indirect markers of the hepatopulmonary syndrome.
abstract: OBJECTIVE
  Hepatopulmonary syndrome (HPS) has been associated with left atrial enlargement, but the presence of other markers of left and right diastolic and/or systolic cardiac dysfunction has not been clarified. We prospectively evaluated the possible associations between echocardiographical-Doppler findings and HPS.
  
  
  METHODS
  Seventy-nine cirrhotic patients without endogenous heart or pulmonary disease were included. HPS was diagnosed by the presence of increased arterial-alveolar-difference and intrapulmonary right-to-left shunt at contrast-enhanced transthoracic echocardiography. Echocardiographical systolic and diastolic indices, tissue Doppler imaging (TDI) of mitral and tricuspid annular motion and M-mode echocardiography measurements were recorded.
  
  
  RESULTS
  Hepatopulmonary syndrome was diagnosed in 12 (15.2%) patients. Patients with compared with those without HPS had significantly younger age, albumin levels and saturation of oxygen (SaO(2)) in an erect position, but higher left ventricular end diastolic diameter (LVEDD), ejection fraction, E-wave peak velocity of tricuspid valve, left atrial volume, TDI E wave (early diastolic period) at the right free wall/tricuspid annulus (cm/s) and TDI S wave (systolic) at the left lateral wall/mitral annulus (TDI Smv). In multivariate analysis, the presence of HPS was found to be independently associated with younger age (P=0.027), lower SaO(2) in an erect position (P=0.023), higher LVEDD (P=0.019) and higher TDI Smv (P=0.026). LVEDD and TDI Smv offered good diagnostic accuracy for HPS diagnosis (AUROC/c-statistic: 0.724 and 0.736 respectively).
  
  
  CONCLUSIONS
  We confirmed that in patients with cirrhosis, the development of HPS is associated with higher cardiac output and hyperdynamic circulation. Left ventricle enlargement and higher systolic velocity in the mitral valve represent satisfactory indirect markers of HPS.
authors.affiliation: Second Department of Medicine, University of Athens Medical School, Hippokration General Hospital, Athens, Greece.
authors.forename: Sophia
authors.initials: S
authors.lastname: Pouriki
authors.forename: Alexandra
authors.initials: A
authors.lastname: Alexopoulou
authors.forename: Christina
authors.initials: C
authors.lastname: Chrysochoou
authors.forename: Leonidas
authors.initials: L
authors.lastname: Raftopoulos
authors.forename: George
authors.initials: G
authors.lastname: Papatheodoridis
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Pectasides
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016279:Atrial Function, Left; D002302:Cardiac Output; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D005260:Female; D006115:Greece; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D006439:Hemodynamics; D020065:Hepatopulmonary Syndrome / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013318:Stroke Volume; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D016277:Ventricular Function, Left