title: Detection of hepatopulmonary syndrome in patients with liver cirrhosis using 3D contrast echocardiography.
abstract: OBJECTIVE
  Hepatopulmonary syndrome (HPS) is characterised by the triad of advanced liver disease, arterial hypoxaemia and intrapulmonary vascular dilatation (IPVD). The present study aimed to evaluate HPS in patients with liver cirrhosis and the role of three-dimensional (3D) contrast echocardiography in the detection of this syndrome.
  
  
  METHODS
  A total of 78 chronic liver disease patients aged 42 ± 11 years fulfilled the criteria for this study and were subjected to clinical examination, laboratory investigations, arterial blood gases measurement, pulmonary function tests, upper gastrointestinal endoscopy, 3D contrast echocardiography and computed tomography (CT) pulmonary angiography.
  
  
  RESULTS
  According to 3D contrast echocardiography results, we divided the patients into a positive group (n=26) in which patients showed a delayed appearance of contrast in left heart chambers and a negative group (n=52). Among 26 patients of the positive group, nine had hypoxaemia (partial pressure of oxygen (PaO(2)) <70 mm Hg) and were diagnosed as having hepatopulmonary syndrome (HPS), the other 17 who had shown echocardiographic evidence of IPVDs but without hypoxaemia were diagnosed as having sub-clinical HPS. This study showed significant correlation between positive contrast echocardiography findings and duration of liver disease, Child score, cyanosis, clubbing, orthodeoxia, portal vein diameter, spleen size and oesophageal varices grades. No significant correlation was found between 3D contrast echocardiography findings and age, sex, spider naevi and pulmonary function tests. Multivariate logistic regression showed that cyanosis, clubbing, orthodeoxia, Child score and portal vein diameter are independent predictors of HPS.
  
  
  CONCLUSIONS
  Cyanosis, clubbing and platypnoea-orthodeoxia are suggestive indicators of HPS, which can be easily detected by 3D contrast echocardiography which can replace the trans-oesophageal echocardiogram (TEE) in cirrhotic patients.
authors.affiliation: Department of Cardiology, Faculty of Medicine, Tanta University, Al Gharbiyah Governorate, Egypt.
authors.forename: Rania
authors.initials: R
authors.lastname: Gaber
authors.forename: Dina H
authors.initials: DH
authors.lastname: Ziada
authors.forename: Nesreen A
authors.initials: NA
authors.lastname: Kotb
authors.forename: Gehan H
authors.initials: GH
authors.lastname: Abo El-Magd
authors.forename: Manal
authors.initials: M
authors.lastname: Hamisa
mesh_terms: D000328:Adult; D003287:Contrast Media; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D020065:Hepatopulmonary Syndrome / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications*; D016015:Logistic Models; D008297:Male; D045423:Microbubbles; D008875:Middle Aged; D015999:Multivariate Analysis
chemical_list: D003287:Contrast Media