Transthoracic echocardiographic predictive probability of pulmonary hypertension in liver transplant candidates: Implications for clinical practice

Assessment for pulmonary hypertension (PH) is critical in liver transplant (LT) candidates given the significant therapeutic and prognostic implications of elevated pulmonary pressures [1,2]. Currently, transthoracic echocardiography (TTE) is recommended as the screening tool for PH in all LT candidates by the American Association for the Study of Liver Diseases (AASLD) [3]. While there have been extensive research examining the role of TTE in PH assessment, these studies mainly investigated TTE-estimated pulmonary arterial systolic pressures (PASP) as the main surrogate for pulmonary hypertension [4,5,6]. The validity of other echocardiographic markers in PH screening is not well established. We evaluated the utility of TTE in detecting PH among liver transplant candidates from three perspectives: (1) TTE-estimated PASP (2) tricuspid regurgitant (TRV) alone (3) probability-based approach using TRV in conjunction with other echocardiographic markers of PH according to recent guideline [7].