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World J Gastroenterol. Feb 7, 2006; 12(5): 768-771
Published online Feb 7, 2006. doi: 10.3748/wjg.v12.i5.768
Portal vein pulsatility index is a more important indicator than congestion index in the clinical evaluation of right heart function
Cheng-Yen Shih, Sien-Sing Yang, Jui-Ting Hu, Chin-Lin Lin, Yung-Chih Lai, Cheng-Wen Chang
Cheng-Yen Shih, Chin-Lin Lin, Jui-Ting Hu, Yung-Chih Lai, Liver Unit, Cathay General Hospital, Taipei 106, Taiwan，China
Sien-Sing Yang, Liver Unit, Cathay General Hospital, Taipei 106, Taiwan and Medical Faculty, China Medical University, Taichung 400, Taiwan, China
Cheng-Wen Chang, Department of Cardiology, Cathay General Hospital, Taipei 106, Taiwan, China
Supported by the grant from the Cathay Groups, Taipei, Taiwan, China
Correspondence to: Sien-Sing Yang, MD, Professor of Medicine, Director of Liver Unit, Cathay General Hospital, 280 Jen-Ai Road, Sec. 4, Taipei 106, Taiwan, China. yangss@cgh.org.tw
Telephone: +886-2-2708-2121-3123 Fax: +886-2-2707-4949
Received: August 8, 2005
Revised: August 9, 2005
Accepted: August 26, 2005
Published online: February 7, 2006
Abstract

AIM: To study the changes of portal blood flow in congestive heart failure.

METHODS: We studied the congestion index (CI) and portal vein pulsatility index (PI) in patients with varied degrees of congestive heart failure using ultrasonic Doppler. Ten patients with mean right atrial pressure (RA) < 10 mmHg were classified as group 1 and the remaining 10 patients with RA ≥ 10 mmHg as group 2.

RESULTS: There were no difference on cardiac index (HI, P = 0.28), aortic pressure (AO, P  = 0.78), left ventricular end-diastolic pressure (LVED, P  = 0.06), maximum portal blood velocity (Vmax, P  = 0.17), mean portal blood velocity (Vmean, P = 0.15) and portal blood flow volume (PBF, P  = 0.95) between the two groups. Group 2 patients had higher pulmonary wedge pressure (PW, 29.9 ± 9.3 mmHg vs 14.6 ± 7.3 mmHg, P = 0.002), pulmonary arterial pressure (PA, 46.3 ± 13.2 mmHg vs 25.0±8.2 mmHg, P =0.004), RA (17.5±5.7 mmHg vs 4.7 ± 2.4 mmHg, P  < 0.001), right ventricular end-diastolic pressure (RVED, 18.3 ± 5.6 mmHg vs 6.4 ± 2.7 mmHg, P < 0.001), CI (8.7 ± 2.4 vs 5.8 ± 1.2, P  = 0.03), and PI (87.8 ± 32.3% vs 27.0 ± 7.4%, P  < 0.001) than Group 1. CI was correlated with PI (P  < 0.001), PW (P  < 0.001), PA (P  < 0.001), RA (P  = 0.043), RVED (P  = 0.005), HI (P  < 0.001), AO (P  < 0.001), CO (P  < 0.001), LVED (P  < 0.001), Vmax (P  < 0.001), Vmean (P  < 0.001), cross-sectional area of the main portal vein (P  < 0.001) and PBF (P  < 0.001). CI could be as high as 8.3 in patients with RA < 10 mmHg and as low as 5.9 in those with RA ≥ 10 mmHg.

CONCLUSION: Our data show that RI is a more significant indicator than CI in the clinical evaluation of high RA ≥ 10 mmHg, whereas CI is better than PI in the assessment of left heart function.

Keywords: Portal blood flow; Heart failure; Ultrasonic Doppler; Congestion index; Portal vein pulsatility index