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. 2021 Oct;16(4):344-352.
doi: 10.17085/apm.21028. Epub 2021 Oct 29.

Preoperative 2D-echocardiographic assessment of pulmonary arterial pressure in subgroups of liver transplantation recipients

Jungchan Park  1 , Myung Soo Park  2 , Ji-Hye Kwon  1 , Ah Ran Oh  1 , Seung-Hwa Lee  3 , Gyu-Seong Choi  4 , Jong Man Kim  4 , Keoungah Kim  5 , Gaab Soo Kim  1
Affiliations

Preoperative 2D-echocardiographic assessment of pulmonary arterial pressure in subgroups of liver transplantation recipients

Jungchan Park et al. Anesth Pain Med (Seoul). 2021 Oct.

Abstract

Background: The clinical efficacy of preoperative 2D-echocardiographic assessment of pulmonary arterial pressure (PAP) has not been evaluated fully in liver transplantation (LT) recipients.

Methods: From October 2010 to February 2017, a total of 344 LT recipients who underwent preoperative 2D-echocardiography and intraoperative right heart catheterization (RHC) was enrolled and stratified according to etiology, disease progression, and clinical setting. The correlation of right ventricular systolic pressure (RVSP) on preoperative 2D-echocardiography with mean and systolic PAP on intraoperative RHC was evaluated, and the predictive value of RVSP > 50 mmHg to identify mean PAP > 35 mmHg was estimated.

Results: In the overall population, significant but weak correlations were observed (R = 0.27; P < 0.001 for systolic PAP, R = 0.24; P < 0.001 for mean PAP). The positive and negative predictive values of RVSP > 50 mmHg identifying mean PAP > 35 mmHg were 37.5% and 49.9%, respectively. In the subgroup analyses, correlations were not significant in recipients of deceased donor type LT (R = 0.129; P = 0.224 for systolic PAP, R = 0.163; P = 0.126 for mean PAP) or in recipients with poorly controlled ascites (R = 0.215; P = 0.072 for systolic PAP, R = 0.21; P = 0.079 for mean PAP).

Conclusions: In LT recipients, the correlation between RVSP on preoperative 2D-echocardiography and PAP on intraoperative RHC was weak; thus, preoperative 2D-echocardiography might not be the optimal tool for predicting intraoperative PAP. In LT candidates at risk of pulmonary hypertension, RHC should be considered.

Keywords: Catheterization; Echocardiography; Hypertension; Liver transplantation; Pulmonary; Swan-ganz.

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Conflict of interest statement

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Scatter plot of the entire population. sPAP: systolic pulmonary arterial pressure, mPAP: mean pulmonary arterial pressure.
Fig. 2.
Fig. 2.
Scatter plots according to type of liver transplantation. sPAP: systolic pulmonary arterial pressure, mPAP: mean pulmonary arterial pressure.
Fig. 3.
Fig. 3.
Scatter plots according to degree of ascites. sPAP: systolic pulmonary arterial pressure, mPAP: mean pulmonary arterial pressure.
Fig. 4.
Fig. 4.
Bland-Altman plot of systolic right ventricular pressure (RVSP) on preoperative echocardiography to systolic pulmonary arterial pressure (sPAP).
Fig. 5.
Fig. 5.
Bland-Altman plot of systolic right ventricular pressure (RVSP) on preoperative echocardiography to mean pulmonary arterial pressure (mPAP); the bias was 12.79 mmHg, and the 95% limits of agreement were 27.17 and –1.59 mmHg.
See this image and copyright information in PMC

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