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

Acar, Emrah; İzcı, Servet; İnanır, Mehmet; Yılmaz, Mehmet; İzgi, İbrahim Akın; Gökçe, Mustafa; Kırma, Cevat

doi:10.1002/jcu.22825

Cited by 2 publications

(2 citation statements)

References 25 publications

(92 reference statements)

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“…The link between congestive heart failure, right ventricular failure, and liver dysfunction has been highlighted in the past decades [ 21 , 22 , 23 ]. Right ventricular failure can lead to hepatic dysfunction, ranging from mild enzyme elevations to severe hepatic fibrosis [ 7 , 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Association between Hepatic Venous Congestion and Adverse Outcomes after Cardiac Surgery

et al. 2022

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Introduction: Hepatic venous flow patterns reflect pressure changes in the right ventricle and are also markers of systemic venous congestion. Fluid management is crucial in patients undergoing cardiac surgery. Methods: Our goal was to determine which factors are associated with the increased congestion of the liver as measured by Doppler ultrasound in patients undergoing cardiac surgery. This prospective, observational study included 41 patients without preexisting liver disease who underwent cardiac surgery between 1 January 2021 and 30 September 2021 at a tertiary heart center. In addition to routine echocardiographic examination, we recorded the maximal velocity and velocity time integral (VTI) of the standard four waves seen in the common hepatic vein (flow profile) using Doppler ultrasound preoperatively and at the 20–24th hour of the postoperative period. The ratios of the retrograde and anterograde hepatic venous waves were calculated, and the waveforms were compared to the baseline value and expressed as a delta ratio. Demographic data, pre- and postoperative echocardiographic parameters, intraoperative variables (procedure, cardiopulmonary bypass time), postoperative factors (fluid balance, vasoactive medication requirement, ventilation time and parameters) and perioperative laboratory parameters (liver and kidney function tests, albumin) were used in the analysis. Results: Of the 41 patients, 20 (48.7%) were males, and the median age of the patients was 65.9 years (IQR: 59.8–69.9 years). Retrograde VTI growth showed a correlation with positive fluid balance (0.89 (95% CI 0.785–0.995) c-index. After comparing the postoperative echocardiographic parameters of the two subgroups, right ventricular and atrial diameters were significantly greater in the “retrograde VTI growth” group. The ejection fraction and decrement in ejection fraction to preoperative parameters were significantly different between the two groups. (p = 0.001 and 0.003). Ventilation times were longer in the retrograde VTI group. The postoperative vs. baseline delta VTI ratio of the hepatic vein correlated with positive fluid balance, maximum central venous pressure, and ejection fraction. (B = −0.099, 95% CI = −0.022–0.002, p = 0.022, B = 0.011, 95% CI = 0.001–0.021, p = 0.022, B = 0.091, 95% CI = 0.052–0.213, p = 0.002, respectively.) Conclusion: The increase of the retrograde hepatic flow during the first 24 h following cardiac surgery was associated with positive fluid balance and the decrease of the right ventricular function. Measurement of venous congestion or venous abdominal insufficiency seems to be a useful tool in guiding fluid therapy and hemodynamic management.

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Section: Discussionmentioning

confidence: 99%

Association between Hepatic Venous Congestion and Adverse Outcomes after Cardiac Surgery

et al. 2022

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“…However, study population of this study was much larger than those of previous studies. 21,22,33,56 Second, although documented liver disease was excluded in this study, we could not fully exclude the presence of subsequent liver diseases, which may have affected the HV waveforms. Third, the relationships between HV waveforms and other estimations, such as liver biopsy, or other imaging, such as computed tomography and magnetic resonance imaging, were not examined in this study.…”

Section: Limitationsmentioning

confidence: 99%

Liver Congestion Assessed by Hepatic Vein Waveforms in Patients With Heart Failure

et al. 2021

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Background: It has been reported that the pattern of hepatic vein (HV) waveforms determined by abdominal ultrasonography is useful for the diagnosis of hepatic fibrosis in patients with chronic liver disease. We aim to clarify the clinical implications of HV waveform patterns in patients with heart failure (HF). Methods: We measured HV waveforms in 350 HF patients, who were then classified into 3 categories based on their waveforms: those with a continuous pattern (C group); those whose V wave ran under the R ESUM E

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

Cited by 2 publications

References 25 publications

Association between Hepatic Venous Congestion and Adverse Outcomes after Cardiac Surgery

Association between Hepatic Venous Congestion and Adverse Outcomes after Cardiac Surgery

Liver Congestion Assessed by Hepatic Vein Waveforms in Patients With Heart Failure

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