Portal vein flow is associated to central hemodynamics and biochemical signs of liver lesion in chronic congestive heart failure

Czech version

Authors: E. Goncalvesová; P. Lesný; P. Chňupa; M. Luknár; J. Fabián
Authors‘ workplace: Transplantačné oddelenie Slovenského ústavu srdcových a cievnych chorôb, Bratislava, Slovenská republika primár prof. MUDr. Juraj Fabián, DrSc.
Published in: Vnitř Lék 2005; 51(5): 533-538
Category: Original Contributions

Overview

Chronic congestive heart failure (CHF) is a syndrome with multiorgan manifestation. During chronic congestive HF changes in portal vein (PV) flow develop. Instead of normal continuous, pulsatile flow with higher diastolic velocity appears. Aim of the study was to describe PV flow characteristics in advanced CHF and compared them with parameters of central hemodynamics and biochemical sings of liver lesion.

Patients and methods:
74 pts (60 males) aged 47.2 ± 20.2 year with severe left ventricular systolic dysfunction (left ventricular ejection fraction 21 ± 4.1%) were evaluated. Portal vein flow was sampled from the main portal vein using intercostal approach. Systolic and diastolic flow velocities were measured and index of pulsatility (IP, max–min/max PV flow velocity) was calculated. Based on IP patients were assigned to four groups. G1-pts. with continuous or subcontinuous flow in PV, IP < 0.5, n = 12. G2-pts. with pulsatile flow, IP ≥ 5–0.99, n = 30; G3-pts. with intermittent flow, IP = 1, n = 19; G4-pts. with reverse flow during systole, IP > 1, n = 13. Investigation of central hemodynamics using termodilution catheter was done up to 48 hours after echostudies.

Results:
Median of IP in all pts. was 0.85 (0–2). IP ≥ 0.5 were found in 85 % of pts. There was a significant linear correlation of IP and right atrial pressure, pulmonary vascular resistance, and mean pulmonary artery pressure (p < 0.01, r = 0.65, 0.52 and 0.45 resp.). Pts. with severe tricuspid regurgitation (TR) (n = 29) had significantly higher IP in comparison with pts. Without TR or TR of lower degrees (1.1 ± 0.38 vs. 0.69 ± 0.39, p < 0.01). Serum total bilirubin levels were lower in G1 than in the rest of the pts. (10.4 ± 4.4 vs. 25.2 ± 12.4 μmol/l, p < 0.01). We noted a decrease of body mass index (BMI) associated with increase of flow pulsatility. There was a significant difference of BMI comparing G1 with G3 of G4 (27.5 ± 4.3 vs. 22.2 ± 3.2 or 21 ± 2.7).

Conclusion:
In patients with advanced CHF the flow in PV becomes pulsatile. Pulsatility correlates with parameters of central haemodynamics, biochemical signs of congestive liver lesion and nutritional status in patients with advanced CHF.

Key words:
congestive heart failure – portal vein flow – liver lesion

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