Anesth Pain Med.  2021 Oct;16(4):344-352. 10.17085/apm.21028.

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

• Park J
• Park MS
• Kwon JH
• Oh AR
• Lee SH
• Choi GS
• Kim JM
• Kim K
• Kim GS

• KMID: 2524446
• DOI: http://doi.org/10.17085/apm.21028

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).
Conclusion
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.

Keyword

Liver transplantation; Pulmonary pressure; 2D-Echocardiography

Figure

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  Fig. 1. Scatter plot of the entire population. sPAP: systolic pulmonary arterial pressure, mPAP: mean pulmonary arterial pressure.

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  Fig. 2. Scatter plots according to type of liver transplantation. sPAP: systolic pulmonary arterial pressure, mPAP: mean pulmonary arterial pressure.

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  Fig. 3. Scatter plots according to degree of ascites. sPAP: systolic pulmonary arterial pressure, mPAP: mean pulmonary arterial pressure.

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  Fig. 4. Bland-Altman plot of systolic right ventricular pressure (RVSP) on preoperative echocardiography to systolic pulmonary arterial pressure (sPAP).

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  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.

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