Clinical Research
Copyright ©The Author(s)2003. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 15, 2003; 9(8): 1828-1831
Published online Aug 15, 2003. doi: 10.3748/wjg.v9.i8.1828
Percentage of peak-to-peak pulsatility of portal blood flow can predict right-sided congestive heart failure
Jui-Ting Hu, Sien-Sing Yang, Yun-Chih Lai, Cheng-Yen Shih, Cheng-Wen Chang
Jui-Ting Hu, Yun-Chih Lai, Cheng-Yen Shih, Liver Unit, Cathay General Hospital, Taipei, Taiwan
Sien-Sing Yang, Liver Unit, Cathay General Hospital, Taipei and Medical Faculty, China Medical College, Taichung, Taiwan
Cheng-Wen Chang, Department of Cardiology, Cathay General Hospital, Taipei, Taiwan
Author contributions: All authors contributed equally to the work.
Correspondence to: Sien-Sing Yang, MD., Liver Unit, Cathay General Hospital, 280, Jen-Ai Road, Sec. 4, Taipei 106, Taiwan yangss@cgh.org.tw
Telephone: +886-2-2708-2121 Ext 3123 Fax: +886-2-2707-4949
Received: March 28, 2003
Revised: April 2, 2003
Accepted: April 24, 2003
Published online: August 15, 2003
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.

Keywords: $[Keywords]