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Hemodynamic evaluation before liver transplantation: insights into the portal hypertensive syndrome.
J Clin Gastroenterol. 2007 Nov-Dec; 41 Suppl 3:S323-9.JC

Abstract

The cardiac hemodynamics of patients awaiting liver transplantation is complex. Coronary atherosclerosis, a hyperdynamic circulatory state and cirrhotic cardiomyopathy are present to a variable degree in this population. In this contribution to the Symposium on Portal Hypertension, we expand on our published experience with coronary angiography and cardiac hemodynamics at the time of evaluation of candidacy for liver transplantation in a cohort of 161 patients. Although we confirmed the relation of systemic hemodynamics with the degree of liver failure, we noted a higher prevalence of high output heart failure, defined as an increased left ventricular end-diastolic pressure in the setting of an elevated cardiac output, most notably in patients classified as Child C. Most patients with high pulmonary artery pressure also exhibited evidence of elevated left ventricle filling pressures. A low systemic vascular resistance, a marker of arterial vasodilatation, was similar in the presence of atherosclerosis, a condition where impaired vasorelaxation occurs as a result of endothelial dysfunction. The high prevalence of coronary artery disease in this series supports the observations that atherosclerosis is a major issue in the current population with cirrhosis awaiting liver transplantation. A lower sensitivity of noninvasive screening tools for the detection of coronary atherosclerosis is likely the result of the interaction of the hyperdynamic circulation with the performance of these tests.

Authors+Show Affiliations

Division of Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. a-blei@northwestern.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17975484

Citation

Blei, Andres T., et al. "Hemodynamic Evaluation Before Liver Transplantation: Insights Into the Portal Hypertensive Syndrome." Journal of Clinical Gastroenterology, vol. 41 Suppl 3, 2007, pp. S323-9.
Blei AT, Mazhar S, Davidson CJ, et al. Hemodynamic evaluation before liver transplantation: insights into the portal hypertensive syndrome. J Clin Gastroenterol. 2007;41 Suppl 3:S323-9.
Blei, A. T., Mazhar, S., Davidson, C. J., Flamm, S. L., Abecassis, M., & Gheorghiade, M. (2007). Hemodynamic evaluation before liver transplantation: insights into the portal hypertensive syndrome. Journal of Clinical Gastroenterology, 41 Suppl 3, S323-9.
Blei AT, et al. Hemodynamic Evaluation Before Liver Transplantation: Insights Into the Portal Hypertensive Syndrome. J Clin Gastroenterol. 2007 Nov-Dec;41 Suppl 3:S323-9. PubMed PMID: 17975484.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hemodynamic evaluation before liver transplantation: insights into the portal hypertensive syndrome. AU - Blei,Andres T, AU - Mazhar,Sameer, AU - Davidson,Charles J, AU - Flamm,Steven L, AU - Abecassis,Michael, AU - Gheorghiade,Mihai, PY - 2007/12/13/pubmed PY - 2008/2/7/medline PY - 2007/12/13/entrez SP - S323 EP - 9 JF - Journal of clinical gastroenterology JO - J Clin Gastroenterol VL - 41 Suppl 3 N2 - The cardiac hemodynamics of patients awaiting liver transplantation is complex. Coronary atherosclerosis, a hyperdynamic circulatory state and cirrhotic cardiomyopathy are present to a variable degree in this population. In this contribution to the Symposium on Portal Hypertension, we expand on our published experience with coronary angiography and cardiac hemodynamics at the time of evaluation of candidacy for liver transplantation in a cohort of 161 patients. Although we confirmed the relation of systemic hemodynamics with the degree of liver failure, we noted a higher prevalence of high output heart failure, defined as an increased left ventricular end-diastolic pressure in the setting of an elevated cardiac output, most notably in patients classified as Child C. Most patients with high pulmonary artery pressure also exhibited evidence of elevated left ventricle filling pressures. A low systemic vascular resistance, a marker of arterial vasodilatation, was similar in the presence of atherosclerosis, a condition where impaired vasorelaxation occurs as a result of endothelial dysfunction. The high prevalence of coronary artery disease in this series supports the observations that atherosclerosis is a major issue in the current population with cirrhosis awaiting liver transplantation. A lower sensitivity of noninvasive screening tools for the detection of coronary atherosclerosis is likely the result of the interaction of the hyperdynamic circulation with the performance of these tests. SN - 0192-0790 UR - https://www.unboundmedicine.com/medline/citation/17975484/Hemodynamic_evaluation_before_liver_transplantation:_insights_into_the_portal_hypertensive_syndrome_ L2 - https://doi.org/10.1097/MCG.0b013e318157188e DB - PRIME DP - Unbound Medicine ER -