BackgroundPortopulmonary hypertension (PoPH), associated with increased mortality, can limit treatment options for liver diseases. Data on the continuum of clinical risk related to cardiopulmonary hemodynamics in PoPH are lacking.Methods and ResultsAs part of the United States national Veterans Affairs Clinical Assessment, Reporting, and Tracking database, we performed a retrospective cohort study of adults with cirrhosis undergoing right heart catheterization between October 1, 2017, and September 30, 2022. Pulmonary hypertension (mean pulmonary arterial pressure [mPAP] >20 mm Hg without PoPH) and PoPH (mPAP >20 mm Hg+pulmonary artery wedge pressure ≤15 mm Hg+pulmonary vascular resistance ≥3 WU) were defined by right heart catheterization hemodynamics. Multivariable Cox proportional hazards using natural splines for hemodynamic variables were used to evaluate the association between cardiopulmonary hemodynamics and mortality following right heart catheterization. A total of 4409 patients were included in the final analysis, predominantly men (96.3%), with a mean age of 68.5 years. Pulmonary hypertension and PoPH were observed in 71.6% and 10.2% of the cohort, respectively. Compared with a reference cardiac index of 2.5 L/min per m², the hazard for mortality increased progressively with decreasing cardiac index, even after adjustment for mPAP and pulmonary vascular resistance. The minority of patients with PoPH (N=65, 14.5%) were prescribed pulmonary vasodilator therapy.ConclusionsThese data suggest that pulmonary hypertension and PoPH are prevalent in veterans with chronic liver disease, but low use of targeted PoPH therapy persists. Cardiac function discriminated mortality risk across a wide range of mPAP and pulmonary vascular resistance values and may diagnose and clarify prognosis in this patient population.

中文翻译：

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肝硬化退伍军人心肺血流动力学与死亡率的关系：一项回顾性队列研究

背景门脉性肺动脉高压（PoPH）与死亡率增加相关，可能限制肝脏疾病的治疗选择。缺乏与 PoPH 心肺血流动力学相关的连续临床风险的数据。方法和结果作为美国国家退伍军人事务部临床评估、报告和跟踪数据库的一部分，我们对接受右心导管插入术的成人肝硬化患者进行了回顾性队列研究2017年10月1日至2022年9月30日之间。肺动脉高压（平均肺动脉压[mPAP]>20mmHg，无PoPH）和PoPH（mPAP>20mmHg+肺动脉楔压≤15mmHg+肺血管阻力≥3 WU）由右心导管血流动力学定义。使用自然样条作为血流动力学变量的多变量 Cox 比例风险用于评估右心导管插入术后心肺血流动力学与死亡率之间的关联。最终分析共纳入 4409 名患者，主要为男性（96.3%），平均年龄 68.5 岁。队列中分别有 71.6% 和 10.2% 的人患有肺动脉高压和 PoPH。与2.5 L/min/m ²的参考心脏指数相比，即使在调整mPAP和肺血管阻力之后，死亡风险也随着心脏指数的降低而逐渐增加。少数 PoPH 患者（N=65，14.5%）接受了肺血管扩张剂治疗。结论这些数据表明，肺动脉高压和 PoPH 在患有慢性肝病的退伍军人中普遍存在，但靶向 PoPH 治疗的使用率仍然较低。心脏功能可以通过广泛的 mPAP 和肺血管阻力值来区分死亡风险，并且可以诊断和阐明该患者群体的预后。