Hemodynamic Changes of the Middle Hepatic Vein in Patients with Pulmonary Hypertension Using Echocardiography

Abstract

The aim of this study was to analyze the changes of the middle hepatic vein (MHV) spectra in patients with pulmonary hypertension (PH) caused by congenital heart disease (CHD) and determine the proper parameters of MHV to predict PH. Eighty patients with CHD were included, whose pulmonary artery pressure was measured via right heart catheterization, and the MHV spectra were detected via echocardiography. The peak value of velocity (V) and velocity time integral (VTI) of the waves, including S wave, D wave and A wave, were measured at the end of inspiration. The values of the MHV parameters that were predictive of PH were evaluated and their cut-off points were determined. Compared with the control group, V of S wave (S), VTI of S wave (SVTI), V of D wave (D), VTI of D wave (DVTI) decreased and V of A wave (A), VTI of A wave (AVTI), A/S, AVTI/SVTI, A/(S+D), AVTI/ (SVTI+DVTI) increased in the PH group. These differences were statistically significant (P<0.05). A correlation analysis determined that the ratios of A/S, A/(S+D), AVTI/(SVTI+DVTI) were positively correlated with pulmonary artery mean pressure (r=0.529,0.575,0.438,P<0.001). An ROC curve analysis determined that the diagnostic effect of A/(S+D) was superior to the other two parameters. On the ROC curve, when the ratio of A/(S+D) was 0.30, the sensitivity was 85.37% and specificity was 75.00% for predicting PH. The spectral parameters of MHV, including the ratios of A/S, A/(S+D) and AVTI/(SVTI+DVTI), increased with increasing pulmonary pressure in CHD patients. When the ratio of A/(S+D) was 0.30 in MHV spectra, it had sufficient sensitivity and specificity for diagnosing PH, and this method could be used as a new non-invasive complementary echocardiographic parameter for predicting PH.

Hepatic Venous Duplex as an Alternative Non- invasive Diagnostic Tool for Diagnosis of Pulmonary Hypertension

“…In their study, they only analyzed the normal basic waveform of hepatic vein, including two antegrade waves ( S wave and D wave) and one retrograde (A wave). 8 In this study, 19 patients showed normal four phagic waves in hepatic venous duplex where deep S in between small A wave and small V wave and that patients have mild pulmonary hypertension. In 38 moderate PH patients, S wave became very small in between large A wave and small V wave are seen.…”

Hepatic venous Doppler assessment can anticipate simplified pulmonary embolism severity index and right ventricle dysfunction in patients with acute pulmonary embolism

“…19 In addition, the lengthening of isovolumic relaxation due to TR, which often accompanies APE, would lead to increased pressure and volume in the RA during the early rapid emptying phase. 20 This lowers the venous return and also decreases D wave velocity. Acutely developing pulmonary hypertension in APE can also further diminish D wave.…”

“…In APE, RV relaxation is worsened with RVD . In addition, the lengthening of isovolumic relaxation due to TR, which often accompanies APE, would lead to increased pressure and volume in the RA during the early rapid emptying phase . This lowers the venous return and also decreases D wave velocity.…”

Doppler Interrogation of the Femoral Vein in the Critically Ill Patient: The Fastest Potential Acoustic Window to Diagnose Right Ventricular Dysfunction?

“…Normal atrial reversal velocity should be inferior to 50% of the systolic hepatic venous velocity ( 45 ). Higher atrial reversal peak hepatic venous Doppler velocities values have been reported in cases of elevated right atrial pressure ( 46 ), RV diastolic dysfunction ( 47 , 48 ), pulmonic stenosis ( 49 ), and pulmonary hypertension ( 50 – 52 ), regardless of underlying mechanism ( 53 ). Because the hepatic venous Doppler velocity correlates with the CFV Doppler velocity, we elected to apply the same criteria (> 50%) to identify an abnormal reversed CFV Doppler waveform peak velocity.…”