Hepatic Function Predictive Value of Hepatic Venous Waveform versus Portal Vein Velocity in Liver Cirrhosis

Abstract

Background: This study assessed the hepatic vein waveform (HVW) and mean maximum portal vein velocity (MM-PVV) on Doppler ultrasound in patients with liver cirrhosis (LC) and compared it with that of age and sex-matched controls. It correlated the degree of HVW abnormality and MM-PVV changes with liver function based on Child-Turcotte-Pugh (CTP) to determine which was more predictive of CTP. Methods: Sixty patients with LC and 60 healthy controls were consecutively recruited into this study. Each patient was classed based on the CTP system after relevant tests. Doppler evaluation of the hepatic vein (HV) and MM-PVV were performed. HVW obtained was classified either into triphasic, biphasic, or monophasic. Results: Sixty cirrhotic and 60 age-matched control subjects aged 19–69 and 18–69 years, respectively, completed this study. All control subjects had a normal HVW pattern while 46 (76.7%) cirrhotic subjects had abnormal HVW ( P < 0.001). The MM-PVV was significantly lower in cirrhotic subjects than in controls; 22.8 cm/s versus 33.6 cm/s ( P < 0.001). The degree of HVW abnormality among cirrhotics showed a significant positive correlation with CTP ( r = 0.283, P = 0.029). MM-PVV on the other hand showed no correlation with CTP class ( r = −0.124; P = 0.346). Linear regression showed that HVW was a significant predictor of hepatic dysfunction based on CTP. Conclusion: Changes in the waveform pattern of the HVs are a good predictor of the derangement of hepatic function in patients with LC than changes in PVV. HVW pattern could therefore serve as an adjunct to CTP class in hepatic function assessment.

Comparison of portal vein hemodynamics with ultrasound-based elastography for the prediction of liver fibrosis in patients with chronic liver disease

“…Portal vein velocity is considered to be influenced by blood viscosity, portal pressure, A-P/P-V shunt, and collateral vessel development. Despite general consensus that mean maximum portal vein velocity is decreased in patients with cirrhosis 25,26 , there are no standards for predicting liver fibrosis because portal blood flow is influenced by numerous factors, www.nature.com/scientificreports/ such as changes in body position, phase of respiration, timing of meals, exercise, and cardiac output. Portal flow may be unaltered due to a combination of high inflow from splanchnic organs and increased resistance within the liver.…”