Review
Copyright ©The Author(s) 2018.
World J Gastroenterol. Mar 28, 2018; 24(12): 1285-1298
Published online Mar 28, 2018. doi: 10.3748/wjg.v24.i12.1285
Table 1 Hepatopulmonary syndrome-diagnostic criteria
Presence of liver disease and/or portal hypertension AND
Partial pressure of oxygen < 80 mmHg or alveolar–arterial oxygen gradient [P(A-a)O2 gradient] ≥ 15 mmHg (or > 20 mmHg for patients > 65-years-old) while breathing ambient air AND
Documented intrapulmonary vascular dilatation by contrast-enhanced echocardiography or lung perfusion scanning with radioactive albumin
Table 2 Hepatopulmonary syndrome-severity classification
MildAlveolar-arterial oxygen gradient ≥ 15 mmHg, partial pressure of oxygen ≥ 80 mmHg
ModerateAlveolar-arterial oxygen gradient ≥ 15 mmHg, partial pressure of oxygen ≥ 60 mmHg to < 80 mmHg
SevereAlveolar-arterial oxygen gradient ≥ 15 mmHg, partial pressure of oxygen ≥ 50 mmHg to < 60 mmHg
Very severeAlveolar–arterial oxygen gradient ≥ 15 mmHg, partial pressure of oxygen < 50 mmHg
Table 3 Intrapulmonary shunt quantitative classification
Contrast-enhanced echocardiography based on the number of microbubbles passing in the left ventricle
No shuntNo detection of microbubbles
Stage 1< 30 microbubbles
Stage 230-100 microbubbles
Stage 3> 100 microbubbles
Macroaggregated albumin lung perfusion
No shunt< 6% brain uptake of radiolabeled albumin
Intrapulmonary shunt≥ 6% brain uptake of radiolabeled albumin
Table 4 Hepatopulmonary syndrome and cardiac involvement
StudyCirrhotic patientsParameters assessedAssessment toolsAssociations
Karabulut et al[123]36 without HPSRV diastolic dysfunctionM-mode ECHORV diastolic dysfunction-HPS
10 with HPSPVRTDIHPS was associated with higher RV wall thickness (0.61 ± 0.13 cm vs 0.51 ± 0.10 cm) RVEDD (3.81 ± 0.38 cm vs 3.11 ± 0.94 cm)
Systolic PAPRA (3.96 ± 0.53 cm vs 3.58 ± 0.47 cm), systolic PAP (48.9 ± 4.8 mmHg vs 40.6 ± 5.3 mmHg)
PVR (3.97 ± 1.31 Wood’s unit vs 3.25 ± 0.96 Wood’s unit)
Zamirian et al[124]53 without IPSLA dimensionM-mode ECHOIPS was associated with higher LA dimension (4.58 ± 0.54 cm vs 3.87 ± 0.63 cm)
39 with IPSCardiac outputCardiac output (5.62 ± 0.83 L/min vs 4.75 ± 0.76 L/min)
Zamirian et al[126]108 without HPSLA volumeM-mode ECHOGreater LA volume in HPS (55.1 ± 7.5 mL vs 37.1 ± 9.3 mL)
41 with HPSLA volume ≥ 50 mL, AUC: 0.903, sensitivity: 86.3%, specificity: 81.2%
Pouriki et al[127]67 without HPSMarkers of LV and RV diastolic and/or systolic cardiac functionM-mode ECHOHPS was associated with higher LVEDD (OR = 1.230, 95%CI: 1.036-1.482; P = 0.019)
12 with HPSTDIS wave at left lateral wall of MV (TDI) (OR = 1.428, 95%CI: 1.049-1.943; P = 0.026)
S wave lateral ≥ 13.5 cm/s, AUC: 0.736, sensitivity: 83.3%, specificity: 65.7%
LVEDD ≥ 50.5 mm, AUC: 0.724, sensitivity: 75%, specificity: 68.7%
Voiosu et al[128]57 without HPSAssociation between HPS and cirrhotic cardiomyopathyM-mode ECHOHigher RV wall width in HPS (3.8 ± 1.2 mm vs 3.4 ± 0.6 mm)
17 with HPSTDINo association between HPS and cirrhotic cardiomyopathy
No echocardiographic measurement predictive of HPS