Percentage of peak-to-peak pulsatility of portal blood flow can predict right-sided congestive heart failure

Abstract

Aim: To study the change of portal blood flow for the prediction of the status of right-sided heart failure by using non-invasive way.

Methods: We studied 20 patients with rheumatic and atherosclerotic heart diseases. All the patients had constant systemic blood pressure and body weight 1 week prior to the study. Cardiac index (CI), left ventricular end-diastolic pressure (LVEDP), mean aortic pressure (AOP), pulmonary wedge pressure (PWP), mean pulmonary arterial pressure (PAP), mean right atrial pressure (RAP), right ventricular end-diastolic pressure (RVEDP) were recorded during cardiac catheterization. Ten patients with RAP >10 mmHg were classified as Group 1. The remaining 10 patients with RAP >=10 mmHg were classified as Group 2. Portal blood velocity profiles were studied using an ultrasonic Doppler within 12 h after cardiac catheterization.

Results: CI, AOP, and LVEDP had no difference between two groups. Patients in Group 1 had normal PWP (14.6+/-7.3 mmHg), PAP (25.0+/-8.2 mmHg), RAP (4.7+/-2.4 mmHg), and RVEDP (6.4+/-2.7 mmHg). Patients in Group 2 had increased PWP (29.9+/-9.3 mmHg), PAP (46.3+/-13.2 mmHg), RAP (17.5+/-5.7 mmHg), and RVEDP (18.3+/-5.6 mmHg) (P<0.001). Mean values of maximum portal blood velocity (Vmax), mean portal blood velocity (Vmean), cross-sectional area (Area) and portal blood flow volume (PBF) had no difference between 2 groups. All the patients in Group 1 had a continuous antegrade portal flow with a mean percentage of peak-to-peak pulsatility (PP) 27.0+/-8.9 % (range: 17-40 %). All the patients in Group 2 had pulsatile portal flow with a mean PP 86.6+/-45.6 (range: 43-194 %). One patient had a transient stagnant and three patients had a transient hepatofugal portal flow, which occurred mainly during the ventricular systole. Vmax, Vmean and PBF had a positive correlation with CO (P<0.001) but not with AOP, LVEDP, PWP, PAP, RAP, and RVEDP. PP showed a good correlation (P<0.001) with PWP, PAP, RAP, and RVEDP but not with CI, AOP, and LVEDP. All the patients with PP >40 % had a right-sided heart failure with a RAP=10 mmHg.

Conclusion: The measurement of PP change is a simple and non-invasive way to identify patients with right heart failure.

Figure 1

Mean portal blood velocity (Vmean) was calculated (cm/s) by the equation of “Vmean = 0.57×maximum portal blood velocity (Vmax)”.

Figure 2

Representative waveform of portal blood flow from patients with normal (A; PP: 17%), transiently reduced (B; PP: 60%), stagnant (C; PP: 100%) or retrograde (D; PP: 194%) portal blood flow.

Figure 3

Occurrence of reduced portal blood flow immedi-ately after ventricular systole.

Figure 4

The occurrence of transient hepatofugal portal blood flow immediately after ventricular systole.