Accuracy of doppler echocardiography in the assessment of pulmonary hypertension in liver transplant candidates

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Abstract
Pulmonary hypertension has been associated with poor outcome after liver transplantation. We assessed the diagnostic accuracy of Doppler echocardiography in detecting significant pulmonary hypertension. Seventy-four potential liver transplant candidates underwent Doppler echocardiography in which the systolic right ventricular pressure (RVsys) was used to estimate the systolic pulmonary artery pressure (PAsys). Group 1 included 39 consecutive patients with RVsys ≥50 mm Hg who underwent elective right heart catheterization. Group 2 consisted of 35 patients with RVsys r = .78, P < .01). Of the 39 patients in group 1, 29 (72%) had at least moderate pulmonary hypertension (mean pulmonary artery pressure [MPAP] ≥35 mm Hg), including 12 (30%) with severe pulmonary hypertension (MPAP ≥50 mm Hg). Only 1 of the group 2 patients had MPAP ≥35 mm Hg. Thus, in the diagnosis of moderate to severe pulmonary hypertension, the sensitivity of echocardiography was 97% and specificity was 77%. Doppler echocardiography is an accurate screening test to detect moderate to severe pulmonary hypertension. We advise that liver transplant candidates with RVsys ≥50 mm Hg undergo right heart catheterization to fully characterize pulmonary hemodynamics.