Detection of hepatopulmonary syndrome in patients with liver cirrhosis using 3D contrast echocardiography

Background and study aims: Hepatopulmonary syndrome (HPS) is characterised by triad of advanced liver disease, hypoxaemia and intrapulmonary vascular dilatation (IPVD). This study aimed to evaluate HPS in patients with liver cirrhosis and the role of 3D contrast echocardiography in detection of this syndrome. Patients and methods: 78 chronic liver disease patients fulfilled the criteria for this study; were subjected to clinical examination, arterial blood gases, pulmonary function tests, upper gastrointestinal endoscopy, 3D contrast echocardiography and CT pulmonary angiography. Results: According to 3D contrast echocardiography results, we divided the patients into positive group (26) in which patients showed delayed appearance of contrast in left heart chambers and negative group (52). Among 26 patients of positive group, 9 had hypoxaemia were diagnosed as having HPS, the other 17 had shown echocardiographic evidence of IPVDs but without hypoxaemia were diagnosed as subclinical HPS. This study showed significant correlation between positive echocardiography and duration of liver disease, Child score, cyanosis, clubbing, orthodeoxia, portal vein diameter and oesophageal varices. No significant correlation was found between 3D contrast echocardiography and age, sex, spider naevi and pulmonary function tests. Multivariate logistic regression showed that cyanosis, clubbing, orthodeoxia, Child score and portal vein diameter are independent predictors of HPS. Conclusion: Cyanosis, clubbing and platypnoea-orthodeoxia are suggestive indicators of HPS, which can be easily detected by 3D contrast echocardiography which can replace trans-oesophageal echocardiogram in cirrhotic patients.