| Hemodynamic evaluation before liver transplantation: insights into the portal hypertensive syndrome. | |
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MedLine Citation:
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PMID: 17975484 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Andres T Blei; Sameer Mazhar; Charles J Davidson; Steven L Flamm; Michael Abecassis; Mihai Gheorghiade |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of clinical gastroenterology Volume: 41 Suppl 3 ISSN: 0192-0790 ISO Abbreviation: J. Clin. Gastroenterol. Publication Date: 2007 Nov-Dec |
Date Detail:
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Created Date: 2007-11-02 Completed Date: 2008-02-06 Revised Date: 2008-07-10 |
Medline Journal Info:
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Nlm Unique ID: 7910017 Medline TA: J Clin Gastroenterol Country: United States |
Other Details:
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Languages: eng Pagination: S323-9 Citation Subset: IM |
Affiliation:
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Division of Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. a-blei@northwestern.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cardiac Output Catheterization, Swan-Ganz Cohort Studies Coronary Angiography Coronary Artery Disease / complications, physiopathology*, surgery Coronary Circulation* Female Heart Failure / complications, physiopathology*, surgery Hemodynamics* Humans Hypertension, Portal / complications, etiology, physiopathology*, surgery Hypertension, Pulmonary / complications, physiopathology*, surgery Liver Cirrhosis / complications*, physiopathology, surgery Liver Transplantation* Male Middle Aged Preoperative Care Retrospective Studies Severity of Illness Index Syndrome Vascular Resistance Ventricular Function, Left |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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