Assessing Splanchnic Compartment Using Portal Venous Doppler and Impact of Adding It to the EVEREST Score for Risk Assessment in Heart Failure

Abstract

Background The Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study with Tolvaptan (EVEREST) score has proven useful for risk prediction in acute decompensated heart failure (ADHF). However, this score does not include the characterization of the splanchnic compartment, which has been involved in worsening heart failure. Refining this score by integrating an assessment of the splanchnic compartment would allow for a better risk assessment. Therefore, we aimed to characterize the patterns of portal vein pulsatility (PVP), an ultrasound metric used for the assessment of splanchnic compartment and their determinants in patients with ADHF, to explore the relationships between abnormal patterns of PVP and outcomes, and to evaluate the added value of PVP to the EVEREST score for risk assessment in ADHF. Methods Portal vein flow was assessed prospectively on admission and at discharge in 95 patients with ADHF using pulsed-wave Doppler. Abnormal PVP was defined for values ≥ 50%. Cox proportional hazards models were used for the assessment of the relationship between PVP and outcomes. Results Overall, 64% of patients on admission and 24% at discharge had abnormal PVP. PVP on admission was inversely correlated with right ventricular function (tricuspid annular plane systolic excursion, ρ = −0.434) and pulmonary pressure (ρ = 0.346), P < 0.05. Although PVP was associated with all-cause mortality (hazard ratio, 1.028, P < 0.001), the addition of this metric to the EVEREST score had little effect on its C-index (0.813 vs 0.818) for risk assessment. Conclusions Abnormal PVP is frequent and associated with right ventricular dysfunction in ADHF. Although abnormal PVP identifies higher-risk patients, this metric does not improve the performance of the EVEREST score for risk assessment.

Usefulness of Serial Multiorgan Point-of-Care Ultrasound in Acute Heart Failure: Results from a Prospective Observational Cohort

“…Additionally, the hepatic veins in patients with rhythm disorders or with intracardiac devices might be difficult to interpret [33]. Therefore, selecting patients with a portal vein determination could be enough, as supported by other studies [18][19][20]24,34]. Regarding, intra-renal Doppler, some observational studies pointed out that severe congestion (monophasic pattern) was associated with an adverse prognosis in AHF [27,35].…”

“…The EVEREST grading score [24], as a clinical course marker of congestion during hospitalization, was calculated for each patient, at admission and at discharge.…”

“…Currently, there is an increasing use of ultrasound parameters in the systemic congestion based on venous Doppler ultrasound, such as the hepatic and portal veins assessment [14][15][16][17][18][19][20][21][22][23][24], described more than 20 years ago, or more recent, the intra-renal vein Doppler [25][26][27][28][29][30]. Recently, it has been proven useful when integrated into a multiorgan POCUS protocol, such as the venous excess ultrasonography (VE × US) score in postoperative cardiac patients [9,31].…”

“…Recently, it has been proven useful when integrated into a multiorgan POCUS protocol, such as the venous excess ultrasonography (VE × US) score in postoperative cardiac patients [9,31]. However, only one study regarding the portal vein [24] and two studies on the intra-renal vein Doppler [27,29] have an adequate methodology in AHF patients. To the best of our knowledge, the formulation of such an approach is in need in hospitalized AHF patients.…”

Point of care venous Doppler ultrasound: Exploring the missing piece of bedside hemodynamic assessment

“…Similar to HV, the recent focus has been to study the impact of PV pulsatility on clinical outcomes. In patients with decompensated heart failure, increased PV pulsatility was associated with worse clinical outcomes if present at discharge and predicted response to diuresis at admission[ 43 , 44 ] . In cardiac surgery patients, PV pulsatility was associated with congestive encephalopathy and delirium[ 11 ] , AKI[ 45 ] and right ventricular dysfunction[ 46 ] .…”