Screening for pulmonary vascular disease (PVD) in patients with portal hypertension by investigating pulmonary hemodynamics during exercise

Introduction: We aimed to assess the frequency of PVD (portopulmonary hypertension (POPH) and hepatopulmonary syndrome (HPS)) in patients with portal hypertension using an algorithm including cardiopulmonary exercise testing (CPET) and exercise echocardiography (TTE ex ). Methods: Patients from our outpatient liver clinic were prospectively enrolled and assigned to a low-, intermediate- or high-risk group according to their resting SPAP and peakVO 2 . In high-risk patients (resting SPAP u003e 50 mmHg) right heart catheterization (RHC) was suggested. Intermediate-risk patients (resting SPAP 35 - 50 mmHg or peakVO 2 ex first. In case of a peakSPAP u003e 50 mmHg, RHC was advised. Results: 205 patients were included (female 25%; cirrhosis 96%; age 57 yr (50 - 62)). There was a significant correlation between Child-Pugh-Stage and peakVO 2 or 6MWD, (R = -0.451 / -0.470, p ex . 18 / 84 patients showed a peakSPAP u003e 50 mmHg. 14 patients underwent RHC revealing 1 patient with POPH and 4 patients with mPAP u003e 30 mmHg and TPR u003e 3 WU at peak exercise. Conclusion: In unselected patients with portal hypertension, using an approach including CPET, TTE ex and RHC, IPVD (37%) and HPS (30%) were frequent, whereas POPH (2%) was rare. Hepatic failure is associated with highly significant impairment of exercise capacity, independent of PAP.