Accuracy of doppler-estimated pulmonary vascular resistance in patients before liver transplantation
Accuracy of doppler-estimated pulmonary vascular resistance in patients before liver transplantation
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DOI：
10.1016/j.amjcard.2007.07.086
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发表时间：
2008-01-15
影响因子：
2.8
通讯作者：
Foster, Elyse
中科院分区：
文献类型：
--
作者：
Farzaneh-Far, Ramin;McKeown, Barry H.;Foster, Elyse
与肝硬化相关的高动力循环的典型特征是高心输出量和低全身和肺血管阻力（PVR）。大约4%的肝硬化患者发生门脉高压，这是原位肝移植术后血流动力学不稳定的重要预测因素。多普勒估计肺动脉收缩压（PASP）被用作门脉高压存在的筛查试验。我们测试了无创性测量PVR（三尖瓣峰值加速速度[TRV]与右心室流出道速度时间积分[VTIRVOT]的比值）的准确性，以检测肝移植前人群中PVR的增加。我们比较了TRV/VTIRVOT比值与超声心动图衍生的PASP的测试特征，以检测侵入性测量的PVR > 1.5 Wood单位。多普勒衍生的PASP与侵入性测量的PVR之间无显著相关性。TRV/VTIRVOT比值与侵入性测量的PVR之间存在中度和显著相关性。与多普勒衍生的PASP相比，TRV/ VTIRVOT比是PVR > 1.5 Wood单位的更准确的测试。使用TRV/VTIRVOT >0.12的临界值，PVR >1.5 Wood单位的灵敏度和阴性预测值为100%。总之，TRV/VTIRVOT比是一个更准确的筛选试验存在门静脉高压比PASP原位肝移植患者。常规使用该比值可能会减少该患者人群中有创血流动力学评估的需求。(C)2008年爱思唯尔公司All rights reserved.
The hyperdynamic circulation associated with cirrhosis is typically characterized by high cardiac output and low systemic and pulmonary vascular resistance (PVR). Approximately 4% of cirrhotic patients develop portopulmonary hypertension, which is an important predictor of hemodynamic instability after orthotopic liver transplantation. Doppler estimation of pulmonary artery systolic pressure (PASP) is used as a screening test for the presence of portopulmonary hypertension. We tested the accuracy of a noninvasive measurement of PVR (ratio of peak tricuspid regurgitant velocity [TRV] to right ventricular outflow tract velocity time integral [VTIRVOT]) to detect increased PVR in a population before, liver transplantation. We compared test characteristics of the TRV/VTIRVOT ratio to echocrdiographically derived PASP for detection of invasively measured PVR > 1.5 Wood units. There was no significant correlation between Doppler-derived PASP and invasively measured PVR. There was a moderate and significant correlation between TRV/VTIRVOT ratio and invasively measured PVR. Compared with Doppler-derived PASP, the TRV/ VTIRVOT ratio was a more accurate test for PVR > 1.5 Wood units. Using a cut-off value of TRV/VTIRVOT >0.12, the sensitivity and negative predictive value for PVR >1.5 Wood units were 100%. In conclusion, the TRV/VTIRVOT ratio is a more accurate screening test for the presence of portopulmonary hypertension than PASP in patients undergoing orthotopic liver transplantation. Routine use of this ratio may decrease the need for invasive hemodynamic assessment in this patient population. (C) 2008 Elsevier Inc. All rights reserved.