Transthoracic Contrast Echocardiography to Detect Pulmonary Vascular Dilatation in Liver Cirrhosis Caused by Hepatitis Virus in Taiwan
2010
Background and Purpose: The natural history of hepatopulmonary syndrome (HPS) has high mortality rate in 5 years in patients with liver cirrhosis. Transthoracic contrast echocardiography (TCE) has been a valuable noninvasive tool to detect pulmonary vascular dilatation. Previous studies have disclosed that there is no relationship between the presence or severity of the HPS and the severity of liver disease. However, the status of pulmonary vascular dilatation in liver cirrhosis is lack in Taiwan. We conduct a prospective cohort study to explore the pulmonary vascular dilatation using TCE in hepatitis virus related liver cirrhosis and further correlate with the severity of Child-Turcotte-Pugh (CTP) classification and Model for End-stage Liver Disease (MELD) scores. Material and Methods: During two and one half years period, a consecutive series of 136 patients with pathology and/or image study confirmed liver cirrhosis were enrolled into this study. All patients were seropositive for hepatitis B surface antigen and/or antibody against hepatitis C virus. All patients received transthoracic echocardiography TCE examination after entered the study. Results: Ninety-three (68.4%) of the 136 patients had a positive TCE result. The proportion of patients with positive TCE was significantly higher in CTP classification C (CTP-C) (69/96, 71.9%) and CTP-B (20/29, 69.0%) than in CTP-A (4/11, 45.5%) (P<0.001). The higher the CTP scores, the higher the TCE positive rates were detected. (P<0.001). Using Pearson's correlation, the positive TCE is negatively correlated with MELD (P=0.036), International Normalized Ratio of Prothrombin Time (INR) (P=0.037), and bilirubin (P=0.008). Conclusion: TCE can be a useful non-invasive tool in the detection of pulmonary vascular dilatation in hepatitis virus related liver cirrhosis. The result of positive TCE is correlated with CTP classification. MELD scores, INR and total bilirubin level are negatively association with liver cirrhosis in Taiwan. The pathogenesis and clinical significance of the latter findings await further study.
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