Purpose Pulmonary hypertension (PH) occurs in a fraction of patients with cirrhosis. The basic lesion of PH is pulmonary arteriolar vasoconstriction. Because we have noted possible differences in the prevalence of PH in patients evaluated at a high-altitude center (Denver), we performed a formal analysis to compare the prevalence of PH in cirrhotics at high-altitude (Denver) and low-altitude (Chapel Hill) liver transplantation centers.
Methods All 721 patients evaluated for liver transplantation at each institution between July 1999 and October 2001 were retrospectively analyzed. Estimates of the maximum systolic pulmonary artery pressure (PAP) were made from the tricuspid regurgitation jet velocity (gradient = 4(jet velocity)2) by echocardiography and confirmed by right heart catheterization in selected patients. PH was defined as systolic PAP > 35 mm Hg, 36 to 45 mm Hg mild, 46 to 60 mm Hg moderate, > 60 mm Hg severe.
Results Patients with PH were more likely to have advanced liver disease, restrictive pulmonary function tests, female gender, and evaluation in Denver. The percentage of patients with PH and severe PH in Denver was significantly higher than in Chapel Hill, p < .05. The incidence of PH is shown in the Table.
Conclusions Patients with cirrhosis who are evaluated at a high-altitude center have a significantly higher prevalence and severity of PH compared with patients at a low-altitude center. The explanation for this observation is not known, but we speculate that one possibility is relative hypoxia experienced at high altitude.
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