Association between right heart diastolic function and clinical presentation of chronic venous disease and primary varicose veins of lower extremities

Abstract

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.

Respiratory changes in biometry of suprarenal inferior vena cava in patients with varicose veins of lower extremities

“…This shift can potentially decrease the right heart filling and eliminate the negative influence of the impaired venous return on cardiac physiology – right heart diastolic dysfunction. 22 Compression therapy may cause more cranial shift of the elevated in this cohort indifference points or the shift above the physiological level. It can potentially further increase the right heart filling and cause the worsening of the right heart diastolic function, especially in patients with previously diagnosed right heart diastolic dysfunction 22 and at the beginning of the treatment or adaptation to the increased right heart filling (Table 4).…”

“…Increased IVC collapsibility and smaller IVC diameters in recurrent subgroup can be a sign of preserved elasticity of the caval wall and a sign of the shift of hydrostatic and volume indifference points in caudal direction (lower abdomen), 1,5,11–13 or a sign of the significantly altered pressure gradient between the systemic capillaries and the right heart and impaired peripheral venous return. 22 Possible underlying mechanisms of this finding in recurrent subgroup are significantly altered intraabdominal – IVC recoil pressure and/or distribution of IVC blood volume to lower pressure areas: 26 internal iliac, 28–30 lumbar 31 and renal (gonadal) veins. 29,30,32 This can result in peripheral venous congestion and recurrence 28,30 of varicose veins of lower extremities.…”

“…Older age was associated with smaller expiratory and inspiratory IVC diameters in patients with varicose veins in comparison to those without chronic venous disease. 26,27 This narrowing of IVC with age can be a potential sign/cause of more profound changes in systemic venous return with age in patients with chronic venous disease 22 and a cause of increased rates of chronic venous disease in older population. 17…”

“…Severe chronic venous disease and recurrence of varicose veins are associated with different suprarenal IVC biometry, different central venous compliance and also different right heart filling. 22 These different patterns of the endpoint of systemic venous return can be a sign of different underlying pathophysiological mechanisms in these conditions, 22 and thus, they may require different treatment strategies.…”

“…The first part of our ultrasound examination 22 was the assessment in a physiological upright standing position of the superficial and deep venous systems of the legs. We used compression/release manoeuvre to find the venous incompetence.…”