TY - JOUR
T1 - Cardiopulmonary changes and its association with clinical features in noncirrhotic portal hypertension
AU - Gopalakrishna, Harish
AU - Nguyen, My Le
AU - Mironova, Maria
AU - Viana Rodriguez, Gracia M.
AU - Afruza, Rownock
AU - Chakraborty, Moumita
AU - Menkart, Matthew G.
AU - Oringher, Jenna L.
AU - Scott, Shani
AU - Nair, Gayatri B.
AU - Kleiner, David E.
AU - Koh, Christopher
AU - Fallon, Michael
AU - Sachdev, Vandana
AU - Heller, Theo
N1 - Publisher Copyright:
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
PY - 2025/8/14
Y1 - 2025/8/14
N2 - BACKGROUND Cardiopulmonary changes in noncirrhotic portal hypertension (NCPH) are poorly understood. AIM To investigate cardiopulmonary changes using transthoracic echocardiography (TTE) in NCPH and their correlation with clinical features. METHODS Prospective cohort including 10 preclinical NCPH [without portal hypertension (PH)] and 32 NCPH subjects who underwent TTE with agitated saline injection and comprehensive clinical evaluation were assessed. PH was defined by presence of either varices, ascites or portosystemic shunting. Intrapulmonary vascular dilatation (IPVD) is defined as appearance of microbubbles in the left atrium after three heartbeats. Right ventricular systolic pressure (RVSP) > 38 mmHg was used to identify possible porto-pulmonary hypertension. Cardiomyopathy is defined using cirrhotic cardiomyopathy consortium criteria. RESULTS Among 42 subjects, 17 (40%) had IPVD, 4 (9.5%) had RVSP > 38 mmHg, and 6 (14%) had cardiomyopathy. Aspartate aminotransferase to alanine aminotransferase (AST/ALT) (1.3 vs 1, P = 0.04) and liver stiffness measurement (LSM) (12.4 kPa vs 7.1 kPa, P = 0.03) were higher in those with IPVD. Presence of either LSM > 10 or AST/ALT > 1.2 aided in identifying subjects with IPVD-sensitivity, specificity, and accuracy of 76%. RVSP correlated with oxygen saturation (r = -0.33), and free right hepatic vein pressure (r = 0.43). Those with PH had higher left atrial volume (LAV) (62 mL vs 48 mL, P < 0.01), and LAV index (LAVI) (35 m2 vs 23 m2, P < 0.01) compared to those without PH. Total bile acids, especially primary bile acids positively correlated with LAV (r = 0.36), and LAVI (r = 0.41). CONCLUSION Similar to cirrhotic patients, cardiopulmonary changes are prevalent in NCPH, especially among those with PH. In NCPH, cardiopulmonary changes occur despite preserved synthetic function, suggesting the NCPH model's value in understanding cardiopulmonary dysfunction in liver disease.
AB - BACKGROUND Cardiopulmonary changes in noncirrhotic portal hypertension (NCPH) are poorly understood. AIM To investigate cardiopulmonary changes using transthoracic echocardiography (TTE) in NCPH and their correlation with clinical features. METHODS Prospective cohort including 10 preclinical NCPH [without portal hypertension (PH)] and 32 NCPH subjects who underwent TTE with agitated saline injection and comprehensive clinical evaluation were assessed. PH was defined by presence of either varices, ascites or portosystemic shunting. Intrapulmonary vascular dilatation (IPVD) is defined as appearance of microbubbles in the left atrium after three heartbeats. Right ventricular systolic pressure (RVSP) > 38 mmHg was used to identify possible porto-pulmonary hypertension. Cardiomyopathy is defined using cirrhotic cardiomyopathy consortium criteria. RESULTS Among 42 subjects, 17 (40%) had IPVD, 4 (9.5%) had RVSP > 38 mmHg, and 6 (14%) had cardiomyopathy. Aspartate aminotransferase to alanine aminotransferase (AST/ALT) (1.3 vs 1, P = 0.04) and liver stiffness measurement (LSM) (12.4 kPa vs 7.1 kPa, P = 0.03) were higher in those with IPVD. Presence of either LSM > 10 or AST/ALT > 1.2 aided in identifying subjects with IPVD-sensitivity, specificity, and accuracy of 76%. RVSP correlated with oxygen saturation (r = -0.33), and free right hepatic vein pressure (r = 0.43). Those with PH had higher left atrial volume (LAV) (62 mL vs 48 mL, P < 0.01), and LAV index (LAVI) (35 m2 vs 23 m2, P < 0.01) compared to those without PH. Total bile acids, especially primary bile acids positively correlated with LAV (r = 0.36), and LAVI (r = 0.41). CONCLUSION Similar to cirrhotic patients, cardiopulmonary changes are prevalent in NCPH, especially among those with PH. In NCPH, cardiopulmonary changes occur despite preserved synthetic function, suggesting the NCPH model's value in understanding cardiopulmonary dysfunction in liver disease.
KW - Angiopoietin 2
KW - Bile acids
KW - Cardiomyopathy
KW - Echocardiography
KW - Hepatopulmonary syndrome
KW - Intrapulmonary vascular dilatation
KW - Nodular regenerative hyperplasia
KW - Porto-sinusoidal vascular disease
KW - Portopulmonary hypertension
KW - Vascular cell adhesion molecule 1
UR - https://www.scopus.com/pages/publications/105012943210
UR - https://www.scopus.com/pages/publications/105012943210#tab=citedBy
U2 - 10.3748/wjg.v31.i30.109256
DO - 10.3748/wjg.v31.i30.109256
M3 - Article
C2 - 40904883
AN - SCOPUS:105012943210
SN - 1007-9327
VL - 31
JO - World Journal of Gastroenterology
JF - World Journal of Gastroenterology
IS - 30
M1 - 109256
ER -