Kuwahara N, Honjo T, Sone N, Imanishi J, Nakayama K, Kamemura K, Iwahashi M, Ohta S, Kaihotsu K. Clinical impact of portal vein pulsatility on the prognosis of hospitalized patients with acute heart failure. World J Cardiol 2023; 15(11): 599-608 [PMID: 38058398 DOI: 10.4330/wjc.v15.i11.599]
Corresponding Author of This Article
Tomoyuki Honjo, MD, PhD, Doctor, Department of Cardiology, Shinko Hospital, 1-4-47, Wakinohamacho, Chuo-ku, Kobe 651-0072, Japan. thonjo@honjo-iin.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Naoya Kuwahara, Tomoyuki Honjo, Naohiko Sone, Junichi Imanishi, Kazuhiko Nakayama, Kohei Kamemura, Masanori Iwahashi, Soichiro Ohta, Kenji Kaihotsu, Department of Cardiology, Shinko Hospital, Kobe 651-0072, Japan
Author contributions: Honjo T, Sone N, and Kaihotsu K substantially contributed to the study conceptualization; Kuwahara N and Honjo T substantially contributed to data analysis and interpretation; Honjo T substantially contributed to the manuscript drafting; all authors critically reviewed and revised the manuscript draft and approved the final version for submission.
Institutional review board statement: This study was reviewed and approved by the ethics committee of Shinko Hospital (approval No. 1524).
Informed consent statement: This study was approved by the Institutional Review Board of Shinko Hospital, and all requirements for written informed consent were waived for the use of the patients’ clinical and imaging data.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tomoyuki Honjo, MD, PhD, Doctor, Department of Cardiology, Shinko Hospital, 1-4-47, Wakinohamacho, Chuo-ku, Kobe 651-0072, Japan. thonjo@honjo-iin.com
Received: July 5, 2023 Peer-review started: July 5, 2023 First decision: August 31, 2023 Revised: September 12, 2023 Accepted: November 2, 2023 Article in press: November 2, 2023 Published online: November 26, 2023 Processing time: 141 Days and 3.9 Hours
Abstract
BACKGROUND
Heart failure (HF) causes extracardiac organ congestion, including in the hepatic portal system. Reducing venous congestion is essential for HF treatment, but evaluating venous congestion is sometimes difficult in patients with chronic HF. The portal vein (PV) flow pattern can be influenced by right atrial pressure. Ultrasound images of the PV are quite easy to obtain and are reproducible among sonographers. However, the association between PV pulsatility and the condition of HF remains unclear. We hypothesize that PV pulsatility at discharge reflects the condition of HF.
AIM
To evaluate the usefulness of PV pulsatility as a prognostic marker for hospitalized patients with acute HF.
METHODS
This observational study was conducted from April 2016 to January 2017 and April 2018 to April 2019 at Shinko Hospital. We enrolled 56 patients with acute HF, and 17 patients without HF served as controls. PV flow velocity was measured by ultrasonography on admission and at discharge. We calculated the PV pulsatility ratio (PVPR) as the ratio of the difference between the peak and minimum velocity to the peak velocity. The primary endpoint was cardiac death and HF re-hospitalization. The observation period was 1 year from the first hospitalization. The Kaplan-Meier method was used to determine the stratified composite event-free rates, and the log-rank test was used for comparisons between groups.
RESULTS
On admission, the PVPR was significantly higher in patients with acute HF than controls (HF: 0.29 ± 0.20 vs controls: 0.08 ± 0.07, P < 0.01). However, the PVPR was significantly decreased after the improvement in HF (admission: 0.29 ± 0.20 vs discharge: 0.18 ± 0.15, P < 0.01) due to the increase in minimum velocity (admission: 12.6 ± 4.5 vs discharge: 14.6 ± 4.6 cm/s, P = 0.03). To elucidate the association between the PVPR and cardiovascular outcomes, the patients were divided into three groups according to the PVPR tertile at discharge (PVPR-T1: 0 ≤ PVPR ≤ 0.08, PVPR-T2: 0.08 < PVPR ≤ 0.21, PVPR-T3: PVPR > 0.21). The Kaplan-Meier analysis showed that patients with a higher PVPR at discharge had the worst prognosis among the groups.
CONCLUSION
PVPR at discharge reflects the condition of HF. It is also a novel prognostic marker for hospitalized patients with acute HF.
Core Tip: Although reducing venous congestion is essential for heart failure (HF) treatment, the assessment of venous congestion is sometimes difficult, especially in patients with recurrent HF. Interestingly, a previous study demonstrated a correlation between right atrial pressure and portal vein (PV) flow pattern. However, the association between PV flow and the condition of HF remains unclear. Therefore, we investigated the clinical usefulness of PV pulsatility in hospitalized patients with HF. We found that PV pulsatility reflected not only the condition of HF but also cardiovascular outcomes. Therefore, PV pulsatility may be a novel prognostic marker for hospitalized patients with HF.
