Harish Gopalakrishna, My-Le Nguyen, Maria Mironova, Gracia M Viana Rodriguez, Rownock Afruza, Moumita Chakraborty, Matthew G Menkart, Jenna L Oringher, Shani Scott, Gayatri B Nair, David E Kleiner, Christopher Koh, Michael Fallon, Vandana Sachdev, Theo Heller
{"title":"非肝硬化门脉高压患者的心肺变化及其与临床特征的关系。","authors":"Harish Gopalakrishna, My-Le Nguyen, Maria Mironova, Gracia M Viana Rodriguez, Rownock Afruza, Moumita Chakraborty, Matthew G Menkart, Jenna L Oringher, Shani Scott, Gayatri B Nair, David E Kleiner, Christopher Koh, Michael Fallon, Vandana Sachdev, Theo Heller","doi":"10.3748/wjg.v31.i30.109256","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Cardiopulmonary changes in noncirrhotic portal hypertension (NCPH) are poorly understood.</p><p><strong>Aim: </strong>To investigate cardiopulmonary changes using transthoracic echocardiography (TTE) in NCPH and their correlation with clinical features.</p><p><strong>Methods: </strong>Prospective cohort including 10 preclinical NCPH [without portal hypertension (PH)] and 32 NCPH subjects who underwent TTE with agitated saline injection and comprehensive clinical evaluation were assessed. PH was defined by presence of either varices, ascites or portosystemic shunting. Intrapulmonary vascular dilatation (IPVD) is defined as appearance of microbubbles in the left atrium after three heartbeats. Right ventricular systolic pressure (RVSP) > 38 mmHg was used to identify possible porto-pulmonary hypertension. Cardiomyopathy is defined using cirrhotic cardiomyopathy consortium criteria.</p><p><strong>Results: </strong>Among 42 subjects, 17 (40%) had IPVD, 4 (9.5%) had RVSP > 38 mmHg, and 6 (14%) had cardiomyopathy. Aspartate aminotransferase to alanine aminotransferase (AST/ALT) (1.3 <i>vs</i> 1, <i>P</i> = 0.04) and liver stiffness measurement (LSM) (12.4 kPa <i>vs</i> 7.1 kPa, <i>P</i> = 0.03) were higher in those with IPVD. Presence of either LSM > 10 or AST/ALT > 1.2 aided in identifying subjects with IPVD-sensitivity, specificity, and accuracy of 76%. RVSP correlated with oxygen saturation (<i>r</i> = -0.33), and free right hepatic vein pressure (<i>r</i> = 0.43). Those with PH had higher left atrial volume (LAV) (62 mL <i>vs</i> 48 mL, <i>P</i> < 0.01), and LAV index (LAVI) (35 m<sup>2</sup> <i>vs</i> 23 m<sup>2</sup>, <i>P</i> < 0.01) compared to those without PH. Total bile acids, especially primary bile acids positively correlated with LAV (<i>r</i> = 0.36), and LAVI (<i>r</i> = 0.41).</p><p><strong>Conclusion: </strong>Similar to cirrhotic patients, cardiopulmonary changes are prevalent in NCPH, especially among those with PH. In NCPH, cardiopulmonary changes occur despite preserved synthetic function, suggesting the NCPH model's value in understanding cardiopulmonary dysfunction in liver disease.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 30","pages":"109256"},"PeriodicalIF":5.4000,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404138/pdf/","citationCount":"0","resultStr":"{\"title\":\"Cardiopulmonary changes and its association with clinical features in noncirrhotic portal hypertension.\",\"authors\":\"Harish Gopalakrishna, My-Le Nguyen, Maria Mironova, Gracia M Viana Rodriguez, Rownock Afruza, Moumita Chakraborty, Matthew G Menkart, Jenna L Oringher, Shani Scott, Gayatri B Nair, David E Kleiner, Christopher Koh, Michael Fallon, Vandana Sachdev, Theo Heller\",\"doi\":\"10.3748/wjg.v31.i30.109256\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Cardiopulmonary changes in noncirrhotic portal hypertension (NCPH) are poorly understood.</p><p><strong>Aim: </strong>To investigate cardiopulmonary changes using transthoracic echocardiography (TTE) in NCPH and their correlation with clinical features.</p><p><strong>Methods: </strong>Prospective cohort including 10 preclinical NCPH [without portal hypertension (PH)] and 32 NCPH subjects who underwent TTE with agitated saline injection and comprehensive clinical evaluation were assessed. PH was defined by presence of either varices, ascites or portosystemic shunting. Intrapulmonary vascular dilatation (IPVD) is defined as appearance of microbubbles in the left atrium after three heartbeats. Right ventricular systolic pressure (RVSP) > 38 mmHg was used to identify possible porto-pulmonary hypertension. Cardiomyopathy is defined using cirrhotic cardiomyopathy consortium criteria.</p><p><strong>Results: </strong>Among 42 subjects, 17 (40%) had IPVD, 4 (9.5%) had RVSP > 38 mmHg, and 6 (14%) had cardiomyopathy. Aspartate aminotransferase to alanine aminotransferase (AST/ALT) (1.3 <i>vs</i> 1, <i>P</i> = 0.04) and liver stiffness measurement (LSM) (12.4 kPa <i>vs</i> 7.1 kPa, <i>P</i> = 0.03) were higher in those with IPVD. Presence of either LSM > 10 or AST/ALT > 1.2 aided in identifying subjects with IPVD-sensitivity, specificity, and accuracy of 76%. RVSP correlated with oxygen saturation (<i>r</i> = -0.33), and free right hepatic vein pressure (<i>r</i> = 0.43). Those with PH had higher left atrial volume (LAV) (62 mL <i>vs</i> 48 mL, <i>P</i> < 0.01), and LAV index (LAVI) (35 m<sup>2</sup> <i>vs</i> 23 m<sup>2</sup>, <i>P</i> < 0.01) compared to those without PH. Total bile acids, especially primary bile acids positively correlated with LAV (<i>r</i> = 0.36), and LAVI (<i>r</i> = 0.41).</p><p><strong>Conclusion: </strong>Similar to cirrhotic patients, cardiopulmonary changes are prevalent in NCPH, especially among those with PH. In NCPH, cardiopulmonary changes occur despite preserved synthetic function, suggesting the NCPH model's value in understanding cardiopulmonary dysfunction in liver disease.</p>\",\"PeriodicalId\":23778,\"journal\":{\"name\":\"World Journal of Gastroenterology\",\"volume\":\"31 30\",\"pages\":\"109256\"},\"PeriodicalIF\":5.4000,\"publicationDate\":\"2025-08-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404138/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World Journal of Gastroenterology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3748/wjg.v31.i30.109256\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Gastroenterology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3748/wjg.v31.i30.109256","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：非肝硬化门脉高压（NCPH）的心肺变化尚不清楚。目的：探讨NCPH患者经胸超声心动图（TTE）的心肺变化及其与临床特征的关系。方法：对10例临床前NCPH[无门脉高压（PH）]和32例NCPH患者进行搅拌生理盐水注射TTE并进行综合临床评价的前瞻性队列研究。PH由静脉曲张、腹水或门静脉系统分流的存在来定义。肺内血管扩张（IPVD）被定义为三次心跳后左心房出现微泡。右心室收缩压（RVSP） bbb38 mmHg用于鉴别可能的门肺动脉高压。心肌病的定义采用肝硬化心肌病联盟标准。结果：42例受试者中，17例（40%）有IPVD， 4例（9.5%）有RVSP bb0 38mmhg， 6例（14%）有心肌病。IPVD患者的谷草转氨酶/丙氨酸转氨酶（AST/ALT） （1.3 vs 1, P = 0.04）和肝脏硬度测量（LSM） （12.4 kPa vs 7.1 kPa, P = 0.03）升高。LSM > 10或AST/ALT > 1.2的存在有助于识别ipvd的敏感性、特异性和准确性为76%。RVSP与血氧饱和度（r = -0.33）、游离右肝静脉压（r = 0.43）相关。PH组左房容积（LAV） （62 mL vs 48 mL, P < 0.01）和LAV指数（LAVI） （35 m2 vs 23 m2, P < 0.01）高于无PH组。总胆汁酸，尤其是原胆汁酸与LAV （r = 0.36）和LAVI （r = 0.41）呈正相关。结论：与肝硬化患者类似，NCPH患者的心肺功能改变普遍存在，特别是在ph患者中。在NCPH患者中，尽管保留了合成功能，但仍会发生心肺功能改变，这表明NCPH模型在了解肝病患者心肺功能障碍方面具有重要价值。
Cardiopulmonary changes and its association with clinical features in noncirrhotic portal hypertension.
Background: Cardiopulmonary changes in noncirrhotic portal hypertension (NCPH) are poorly understood.
Aim: To investigate cardiopulmonary changes using transthoracic echocardiography (TTE) in NCPH and their correlation with clinical features.
Methods: Prospective cohort including 10 preclinical NCPH [without portal hypertension (PH)] and 32 NCPH subjects who underwent TTE with agitated saline injection and comprehensive clinical evaluation were assessed. PH was defined by presence of either varices, ascites or portosystemic shunting. Intrapulmonary vascular dilatation (IPVD) is defined as appearance of microbubbles in the left atrium after three heartbeats. Right ventricular systolic pressure (RVSP) > 38 mmHg was used to identify possible porto-pulmonary hypertension. Cardiomyopathy is defined using cirrhotic cardiomyopathy consortium criteria.
Results: Among 42 subjects, 17 (40%) had IPVD, 4 (9.5%) had RVSP > 38 mmHg, and 6 (14%) had cardiomyopathy. Aspartate aminotransferase to alanine aminotransferase (AST/ALT) (1.3 vs 1, P = 0.04) and liver stiffness measurement (LSM) (12.4 kPa vs 7.1 kPa, P = 0.03) were higher in those with IPVD. Presence of either LSM > 10 or AST/ALT > 1.2 aided in identifying subjects with IPVD-sensitivity, specificity, and accuracy of 76%. RVSP correlated with oxygen saturation (r = -0.33), and free right hepatic vein pressure (r = 0.43). Those with PH had higher left atrial volume (LAV) (62 mL vs 48 mL, P < 0.01), and LAV index (LAVI) (35 m2vs 23 m2, P < 0.01) compared to those without PH. Total bile acids, especially primary bile acids positively correlated with LAV (r = 0.36), and LAVI (r = 0.41).
Conclusion: Similar to cirrhotic patients, cardiopulmonary changes are prevalent in NCPH, especially among those with PH. In NCPH, cardiopulmonary changes occur despite preserved synthetic function, suggesting the NCPH model's value in understanding cardiopulmonary dysfunction in liver disease.
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The primary aims of the WJG are to improve diagnostic, therapeutic and preventive modalities and the skills of clinicians and to guide clinical practice in gastroenterology and hepatology.
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