Russian Heart Failure Journal 2014year Some features of pulmonary hypertension development in patients with viral cirrhosis of the liver


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2014/№4

Some features of pulmonary hypertension development in patients with viral cirrhosis of the liver

Chistyakova M. V., Govorin A. V., Radaeva E. V.

Keywords: diagnostics, pulmonary hypertension, cirrhosis


DOI: 10.18087/rhfj.2014.4.1925

Background. Hepatopulmonary syndrome is a difficult to diagnose and severe complication of liver cirrhosis. Aim. To establish the presence of pulmonary hypertension in patients with viral cirrhosis and to study the effect of pulmonary hypertension on parameters of portal hemodynamics, pulmonary ventilation, and EchoCG parameters. Materials and methods. 75 patients (51 % of men and 49 % of women) with Child-Pugh grades A and B viral cirrhosis were evaluated. Based on severity of pulmonary hypertension, patients were divided into the following groups: group 1, patients without pulmonary hypertension, with pulmonary artery systolic pressure (PASP) of <30 mm Hg (n=54); group 2, PASP of 31–39 mm Hg (n=21); control group consisted of 17 subjects. Doppler EchoCG and blood vessel duplex scanning were performed and the function of external respiration was studied. Results. In patients with moderate cirrhosis, pulmonary hypertension is a frequent complication (28 %), and it is generally moderately severe. Pulmonary hypertension is associated with dilated caval veins with reduced caval blood flow velocity (р<0.001), increased left ventricular myocardial mass, LV end-systolic volume, transaortic velocity, left atrial (LA) and pulmonary arterial (PA) enlargement, impaired LV myocardial contractility (р <0.001), impaired LV and RV diastolic function (р<0,001), and impaired external respiration function of restrictive type (р <0.05). Patients with cirrhosis of the liver complicated by moderate pulmonary hypertension were characterized by quite tight relationships not only between different cardiac hemodynamic parameters and hepatic and PA blood velocity parameters but also between caval vein diameter and forced vital capacity (r=0.73; р<0.05), which suggested a high probability for development of collateral circulation, portal-pulmonary anastomoses. Conclusion. In patients with viral cirrhosis of the liver, the increased PA pressure was associated with changes in portal hemodynamic parameters, cardiac hemodynamic parameters, and impaired external respiration function of restrictive type. In patients without pulmonary hypertension, these changes were less pronounced and were not associated with impaired function of pulmonary ventilation. Development of pulmonary hypertension was closely related with the portal blood flow.
  1. Абдуллаев С. М. Гепатопульмональный синдром. Клинич. гепатол. 2007;3:43–46.
  2. Гарбузенко, Д. В. Портопульмональная гипертензия и гепатопульмональный синдром у больных циррозом печени. Пульмонология. 2006;16 (1):103–107.
  3. Калачева Т. П. Функциональное состояние легочно-сердечной гемодинамики при циррозе печени. Автореф. дис…. канд. мед наук. Томск, 2010.
  4. Ильченко Л. Ю, Федоров И. Г, Карабиненко А. А. и др. Гепато­пульмональный синдром: состояние проблемы. Современные технологии в медицине. 2009;1:84–88.
  5. Денисов А. Оценка функции левого и правого желудочков с позиции структурно-функциональных изменений миокарда у больных с хроническими гепатитами и циррозом печени в процессе лечения. Вестник новых медицинских технологий. 2007;2:38–45.
  6. Касьянова Т. Р, Астахин А. В, Левитан Б. Н. и др. Оценка структурно-функциональных показателей правых отделов сердца у больных циррозом печени. Современные проблемы науки и образования. Доступно на: http://www.science-education.ru / 100–5266
  7. Неклюдова Г. В., Калманова Е. Н. Роль эхокардиографии в диагностике легочной гипертензии. Болезни сердца и сосудов. 2006;2 (2):1–18.
  8. Lindqvist P, Waldenström A, Wikström G, Kazzam E. The use of isovolumic contraction velocity to determine right ventricular state of contractility and filling pressures A pulsed Doppler tissue imaging study. Eur J Echocardiogr. 2005 Aug;6 (4):264–70.
  9. Ratti L, Redaelli E, Guidi C et al. Diastolic dysfunction in liver cirrhosis. Gastroenterol Hepatol. 2005 Dec;28 (10):649–55.
  10. Гульман М. И. Роль допплерографии в оценке степени фиброзирования ткани печени при хронических гепатитах и циррозе печени. Сибирский мед. журн. 2005;6:39–41.
Chistyakova M. V., Govorin A. V., Radaeva E. V. Some features of pulmonary hypertension development in patients with viral cirrhosis of the liver. Russian Heart Failure Journal. 2014;85 (4):246–249

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