Assessment of biventricular function in patients with hepatopulmonary syndrome

Comparison of Preoperative and Postoperative Conventional and Speckle Tracking Echocardiographic Parameters in Living Liver Donors

Introduction We aimed to assess whether partial hepatectomy has an influence on conventional and speckle tracking parameters on echocardiography in living liver donors in the early postoperative period. Methods This study was a retrospective study to investigate the cardiac effects of liver donation after the transplant operation in a high-volume liver transplant center. Ninety living liver donors were included in the study. The echocardiographic images were obtained from 90 living liver donors before and five to seven days after the operation. The echocardiographic examinations were evaluated with a Philips Epiq 7 ultrasound system (Philips Ultrasound; Bothell, WA, USA) by experienced cardiologists in accordance with the recommendations of the American Society of Echocardiography. These included M-mode, two-dimensional imaging, tissue Doppler assessment at the septal and lateral mitral annulus, and strain imaging in all patients at rest in the left decubitus position. The changes in echocardiographic parameters in living liver donors were analyzed. Paired T-test was used to assess significant differences. Results The left ventricular (LV) global longitudinal strain (GLS), right ventricular (RV) GLS, and RV free wall LS, reservoir phase of left atrial strain (LAS-r), conduit phase of LAS (LAS-cd) did not show significant changes after the operation (for all, p>0.05). However, the absolute atrial contraction phase of LAS (LAS-ct) mean value increased significantly (14.2±8.8 vs 16.6±8.3, p=0.025) postoperatively. Among the conventional echo parameters, isovolumic relaxation time (IVRT) and the E/A ratio demonstrated notable postoperative alterations. The mean IVRT (87.3 ± 22.4 vs. 80.8 ± 18.1, p=0.014) and E/A ratio (1.5 ± 0.5 vs. 1.3 ± 0.3, p=0.012) exhibited a postoperative decline. Conclusions To the best of our knowledge, our study is the first to evaluate the effect of partial hepatectomy on cardiac functions by echocardiography in living liver donors, and there was no deterioration in the functions of both the ventricles and left atrium.

The Contemporary Role of Speckle Tracking Echocardiography in Cirrhotic Cardiomyopathy

Cirrhotic cardiomyopathy (CCM) is characterized by elevated cardiac output at rest, an inability to further increase contractility under stress, and diastolic dysfunction. The diagnosis of CCM is crucial as it can lead to complications during liver transplantation. However, its recognition poses challenges with conventional echocardiography techniques. Speckle tracking echocardiography (STE), particularly global longitudinal strain (GLS), is a novel index that enhances the diagnostic efficacy of echocardiography for both ischemic and non-ischemic cardiomyopathies. GLS proves more sensitive in identifying early systolic dysfunction and is also influenced by advanced diastolic dysfunction. Consequently, there is an expanding scope for GLS utilization in cirrhotic cases, with newly updated diagnostic criteria for CCM incorporating GLS. Specifically, systolic dysfunction is now defined as either a left ventricular ejection fraction below 50% or an absolute GLS below 18%. However, conflicting data on GLS alterations in liver cirrhosis patients persist, as many individuals with advanced disease and a poor prognosis exhibit a hyperdynamic state with preserved or increased GLS. Consequently, the presence of CCM, according to the updated criteria, does not exhibit a significant association-in the majority of studies-with the severity of liver disease and prognosis. Furthermore, information on other indices measured with STE, such as left atrial and right ventricular strain, is promising but currently limited. This review aims to offer a critical assessment of the existing evidence concerning the application of STE in patients with liver cirrhosis.

Hepatopulmonary syndrome: diagnosis and treatment

Hepatopulmonary syndrome (HPS) is one of the lung diseases associated with liver cirrhosis and portal hypertension. The diagnosis is based on the triad: liver disease and portal hypertension, evidence of intrapulmonary vascular dilatation and impaired gas exchange. HPS impairs prognosis (23 % survival after 5 years) and patients’ quality of life, so early diagnosis and timely treatment are of great importance. Liver transplantation allows for regression of intrapulmonary vascular dilatation in almost 100 % of cases, normalization of gas exchange and improves a 5-year survival after transplantation from 76 to 87 %. This is the only treatment method indicated for patients with severe HPS, defined by an arterial partial pressure of oxygen (PaO2) below 60 mm Hg. However, in the face of a global shortage of transplants, it is necessary to develop medical therapies to delay or even defer liver transplantation. This goal seems possible due to the growing understanding of the HPS pathophysiology and the development of therapies targeting key mechanisms, mainly inflammatory and angiogenic. This article provides an overview of the clinical manifestations, diagnosis and treatment of HPS based on literature sources from the MEDLINE database on the PubMed platform.

Advances in Diagnostic Imaging of Hepatopulmonary Syndrome

Hepatopulmonary syndrome (HPS) is a serious pulmonary complication of progressive liver disease that leads to a poor clinical prognosis. Patients with HPS may develop acute respiratory failure, which requires intensive care and therapy. At present, the only effective treatment is liver transplantation; therefore, early diagnosis and timely treatment are of considerable significance. The three main features of HPS are liver disease, oxygenation disorder, and intrapulmonary vascular dilatation (IPVD). Diagnosing HPS is challenging due to the difficulty in detecting the presence or absence of IPVD. As such, imaging examination is very important for detecting IPVD. This paper reviews the imaging methods for diagnosing HPS such as ultrasound, dynamic pulmonary perfusion imaging, pulmonary angiography, and computed tomography.