Aim This study examines the characteristics of cardiac Doppler in patients with primary varicose veins of lower extremities. Material and methods We performed retrospective descriptive statistical analysis of cardiac Doppler data of 85 patients with primary varicose veins and compared obtained parameters with normal values. Results Patients with primary varicose veins in comparison with normal controls have significantly lower early diastolic mitral and tricuspid inflow velocities (E wave), significantly higher late diastolic mitral and tricuspid inflow and annular velocities (A and a′ waves), significantly higher systolic mitral and tricuspid annular velocities (s′ wave), and they have normal early diastolic mitral and tricuspid annular velocities (e′ wave). Conclusion Cardiac Doppler in patients with primary varicose veins differs significantly from the actual normal values. Possible mechanism of this finding is compensatory increased atrial ejection fraction due to altered preload in patients with primary varicose veins.
Aim This study examines the association between right heart diastolic function and clinical presentation of chronic venous disease and primary varicose veins of lower extremities. Material and methods We performed retrospective analysis of clinical, peripheral venous Duplex and tricuspid Doppler (early diastolic inflow E-wave, late diastolic inflow A-wave, ratios of E to A waves, early diastolic annular e′-wave, late diastolic annular a′-wave and systolic annular s′- wave) data of 85 patients, 133 legs with primary varicose veins. Results We found following significant (p-value < 0.05) associations between tricuspid Doppler and clinical presentation of chronic venous disease and primary varicose veins: Clinical Etiological Anatomical Pathophysiological clinical class influenced late diastolic inflow velocities (C6 class A-wave +11.2 cm/s or +27% in comparison with C2), late diastolic annular velocities (C6 class a′-wave +3.3 cm/s or +22% in comparison with C2), systolic annular velocities (C6 class s′-wave +3.7 cm/s or +27% in comparison with C2) and E/A ratios (C6 class E/A ratio −0.22 or −21% in comparison with C2). Recurrent varices in comparison with previously untreated are associated with significantly lower late diastolic inflow velocities (A-wave −4.4 cm/s or −9%) and preserved E/A ratios. Age significantly influenced tricuspid Doppler (E-, A-, e′-, a′-waves and E/A ratios) in patients with chronic venous disease. Conclusion Clinical presentation of primary varicose veins and chronic venous disease can be associated with the right heart diastolic function: C6 Clinical Etiological Anatomical Pathophysiological class in comparison with C2 is associated with increased right ventricular filling and impaired ventricular relaxation – right heart diastolic dysfunction; recurrent varices in comparison with previously untreated are associated with reduced right ventricular filling and preserved right heart diastolic function. Older age is the most important risk factor for varicose veins and chronic venous disease possible due to significant changes in right ventricular filling and in right heart diastolic function with age.
Aim This study examines respiratory biometry of inferior vena cava in patients with varicose veins of lower extremities. Material and Methods We performed retrospective analysis of clinical and ultrasound data of 67 patients with primary varicose veins. Results The largest expiratory (mean 16.2 mm, p-value 0.09) and inspiratory (mean 8.2 mm, p-value 0.02) inferior vena cava diameters were in C3 Clinical Etiological Anatomical Pathophysiological clinical class; the smallest expiratory diameters (mean 13.1 mm, p-value 0.5) were in C6 class; the smallest inspiratory diameters (mean 4.6 mm, intercept) were in C2 class. C2 class was associated with highest inferior vena cava collapsibility index (mean 68.2%, intercept); C6 class was associated with lowest collapsibility index (mean 48.3%, p-value 0.04). Recurrent varices in comparison with previously untreated were associated with smaller inspiratory diameters of inferior vena cava (mean 4.4 mm, p-value 0.005), smaller expiratory diameters (mean 13.4 mm, p-value 0.06) and higher collapsibility index (mean 68.5%, p-value 0.005). Patients with recurrent and bilateral varicose veins had identical respiratory biometry of inferior vena cava. Older age was associated with smaller inferior vena cava diameters (p-value <0.01). Conclusion Clinical presentation of varicose veins is associated with different respiratory biometry of suprarenal inferior vena cava. C6 clinical class in comparison with C2 clinical class is associated with lower central venous compliance possible due to the narrowing of inferior vena cava. Smaller inferior vena cava diameters and higher collapsibility index in recurrent subgroup in comparison with previously untreated can be a sign of the significantly altered pressure gradient between the systemic capillaries and the right heart and impaired peripheral venous return. Narrowing of inferior vena cava with age can be a sign of more profound changes in systemic venous return with age in patients with varicose veins in comparison to those without chronic venous disease.
Aim This study examines the interactions between central venous and cardiac sonomorphologies to explain the mechanism of impaired heart relaxation in patients with varicose veins of lower extremities. Material and Methods Part 1: We performed retrospective analysis of influences of inferior vena cava (IVC) diameters on tricuspid and mitral inflow and annular velocities in 64 patients with primary varicose veins. Part 2: We compared IVC diameters and IVC collapsibility index (IVC CI) in patients with varicose veins with normal values. Results We found a significant positive influence of an increase in maximal expiratory and minimal inspiratory IVC diameters on mitral and tricuspid early annular velocities or e′-waves ( p-values < .008), inflow velocities or E-waves ( p-values < .05) and early to late inflow E/A ratios ( p-values < .01). Less influenced by the changes in venous biometry ( p-values > .05) were late mitral and tricuspid inflow, annular and systolic velocities (A-, a′-, s-waves). Expiratory and inspiratory diameters in patients with varicose veins were significantly smaller ( p-values < .05 expiratory; < .0001 inspiratory), and IVC CI was significantly higher ( p-values < .0001) than the normal values. Conclusion Chronic venous disease impairs the function and the morphology of the entire inferior caval system and the heart. Impaired relaxation of the heart in patients with varicose veins is the result of two factors: (1) impaired venous return resulting in the low central venous pressure and the low early diastolic cardiac inflow; (2) structural changes in the heart resulting in the compensatory increased late diastolic cardiac inflow. Increase in central venous pressure (IVC diameters) and early diastolic cardiac inflow (E-waves), accompanied by unchanged myocardial response (e′-wave) can serve as marker for return to normal physiology.
Aim This study examines the influence of Earth’s gravity field on the prevalence of varicose veins in geophysical area. Material and Methods We performed a systematic review (OVID and Google Scholar) of studies focusing on prevalence of varicose veins to determine the influence of Earth’s gravity field—GRACE GGM05S gravity model—on the disease prevalence. PROSPERO: CRD42021279513. Results 81 studies met inclusion and quality criteria. Areas with stronger gravity have significantly higher prevalence of varicose veins with adjustment for age, gender and body mass index (BMI) ( p-values < 0.02). Adjusted for age, prevalence of varicose veins in areas with gravity field +20 mGal and more is 1.37 time higher than in areas with gravity field less than +20 mGal, p-value 0.005 (95% CI: −12.5 to −2.4): mean disease prevalence for gravity field +20 mGal and more—27.5% (mean age, 40.1 years; mean gravity field, +27.1 mGal; 63.9% females, 37 studies, 123,164 participants) vs mean disease prevalence for gravity field less than +20 mGal – 20.1% (mean age, 42.2 years; mean gravity field, +5.7 mGal; 56.8% females, 44 studies, 205,925 participants). Older age is the main risk factor for varicose veins ( p-values < 0.005). Female gender and high BMI are insignificantly associated with high prevalence of varicose veins ( p-values > 0.4 for gender, p-values > 0.2 for BMI). Conclusion Stronger gravity field is significantly associated with higher prevalence of varicose veins—risk factor. The potential mechanism of this phenomenon is that high gravity field alters systemic venous return, pooling blood and fluid in the peripheral, gravity-dependent regions of the body in upright humans constantly living in the defined geophysical area.
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