title: Characteristic haemodynamic changes of cirrhosis may influence the diagnosis of portopulmonary hypertension.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Liver Unit Digestive Disease Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Chiva
authors.forename: Cristina
authors.initials: C
authors.lastname: Ripoll
authors.forename: Fernando
authors.initials: F
authors.lastname: Sarnago
authors.forename: Diego
authors.initials: D
authors.lastname: Rincón
authors.forename: Judith
authors.initials: J
authors.lastname: Gómez-Camarero
authors.forename: Evelyn
authors.initials: E
authors.lastname: Galindo
authors.forename: María-Vega
authors.initials: MV
authors.lastname: Catalina
authors.forename: Jaime
authors.initials: J
authors.lastname: Elizaga
authors.forename: Rafael
authors.initials: R
authors.lastname: Bañares
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis* / Q000209:etiology; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric
keywords: liver transplantation; portopulmonary hypertension; pulmonary arterial hypertension; pulmonary vascular resistance; transpulmonary gradient