Spectral Doppler of the Hepatic Veins in Noncardiac Diseases: What the Echocardiographer Should Know

Abstract

In most instances, the flow profile in the hepatic veins (HVs) reflects the fluctuation of pressure within the right atrium. Thus, interrogation of blood flow in the HVs is highly useful for the evaluation of right heart hemodynamics and has become an integral part of any routine echocardiographic examination. However, flow in the HVs is also affected by the state of the liver parenchyma and by the fluctuation of pressure within the thoracic cavity. Therefore, liver and pulmonary pathologies influence the flow pattern in the HVs and may lead to its dissociation from right heart hemodynamics. Echocardiographers should familiarize themselves with the findings on HV Doppler in noncardiac diseases to avoid misinterpretation and incorrect diagnosis.

Characterization of Doppler spectrum of hepatic veins and correlation with structural and functional variables of the right ventricle in healthy dogs

“…Because hepatopathies modify the hepatic venous flow pattern, the results of our study provide a basis for future studies involving animals with changes that affect both the right side of the heart and the liver. More studies regarding hepatic venous flow pattern could help the ultrasonographer distinguish between diseases that cause hepatic congestion because of local disturbance or in response to right‐sided congestive heart failure.…”

“…In people, assessment of hepatic venous flow and its association with right heart hemodynamics is well established . This technique is uncommon in veterinary medicine.…”

“…Normal hepatic venous blood flow has low velocity and a pulsatile pattern that reflects the changes in right atrial pressure throughout the cardiac cycle. Therefore, assessment of hepatic veins using spectral Doppler could provide information about heart function …”

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

“…With regard to the HV waveforms, it has been suggested that the significance of HV waveforms differ depending on the disease. 20,33 In patients with chronic liver disease, HV waveforms are useful for the estimation of liver fibrosis. [20][21][22][23] In patients with liver cirrhosis, the continuous HV waveform (namely C group in this study) is mainly caused by intrahepatic fat deposition, inflammatory or fibrotic changes, and changes in the compliance of the venous wall, suggesting the presence of severe liver fibrosis.…”

“…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.…”