Laurent Dercle MD, Presenter: Nothing to Disclose

Thomas Cognet, Abstract Co-Author: Nothing to Disclose

Olivier Lairez, Abstract Co-Author: Nothing to Disclose

Camille Christol, Abstract Co-Author: Nothing to Disclose

Monia Ouali, Abstract Co-Author: Nothing to Disclose

Marie-Angele Robic, Abstract Co-Author: Nothing to Disclose

Isabelle Berry, Abstract Co-Author: Nothing to Disclose

Christophe Bureau, Abstract Co-Author: Nothing to Disclose

Liver cirrhosis leads to portal hypertension and hyperdynamic circulation that are responsible for hepato-pulmonary syndrome and portopulmonary hypertension. The aim of this study was to determine if gated blood pool SPECT could become a one-stop-shop procedure in order to predict the cardiovascular complications of liver cirrhosis.

100 patients referred for gated blood pool SPECT were prospectively included: 16 cirrhotic patients and a control group (n=84). The parameters of the function of both ventricles were measured: global, regional, systolic, diastolic, synchrony and Spleno-Hepatic Score [SHS]. The SHS is a new score of the severity of the vascular redistribution from liver to spleen due to the portal hypertension and is calculated according to the formula: SHS=(S25*LSD)/(H25*LHD). LSD: longest splenic diameter, LHD: longest hepatic diameter, H25 (S25): mean activity per pixel at the center of the right liver (spleen) in a 25 pixel ROI. The gold standard for the measurement of the portal pressure and of the mean pulmonary arterial pressure were catheter measurement.

Clinical parameters were not statistically different in the two groups. Biological parameters related to liver cirrhosis were statistically different. Concerning the treatment, the proportion of diuretics and inhibitors of angiotensin converting enzyme was significantly higher in the cirrhotic group. By multivariate regression analysis, two parameters were independent predictors of liver cirrhosis: SHS and LVEF. Odds Ratio were: 3.7 for SHS (95CI: 1.4-9.6) and 1.2 for LVEF (95CI: 1.0-1.4). According to ROC curve analysis, the best thresholds were SHS>0.73 (AUC:0.97 (95CI: 0.94-1.00), Sensitivity 88%, Specificity 95%) and LVEF>76% (AUC: 0.90 (95CI: 0.81-0.99), Sensitivity 88%, Specificity 83%). In the liver cirrhosis group, the strongest correlation with the mean pulmonary arterial pressure was for SHS (r=0.56).

Gated blood pool SPECT is efficient to predict the cardiovascular complications of liver cirrhosis. SHS and LVEF are two independent parameters that assess the severity of the vascular redistribution and the hyperdynamic circulation. An increased SHS could be considered as a predictor of an increased pulmonary arterial pressure.

Gated blood pool SPECT could become a one-stop-shop procedure in liver cirrhosis and predict portal hypertension and hyper dynamic circulation.

Dercle, L, Cognet, T, Lairez, O, Christol, C, Ouali, M, Robic, M, Berry, I, Bureau, C, Cardiovascular Consequences of Liver Cirrhosis: Diagnosis of Portal Hypertension and Prediction of Pulmonary Consequences on Equilibrium Radionuclide Ventriculography.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14018376.html