Related Experiment Videos
[Evaluation of hepatic venous flow patterns using a pulsed Doppler technique]
S Sakoda1, K Mitsunami, M Kinoshita
1First Department of Internal Medicine, Shiga University of Medical Science, Ohtsu.
Insights
Pulsed Doppler echocardiography of hepatic venous flow effectively evaluates cardiac function. A significant increase in the velocity ratio after angiotensin II infusion indicates impaired cardiac function, especially in dilated cardiomyopathy.
Area of Science:
- Cardiology
- Medical Imaging
- Hemodynamics
Background:
- Hepatic venous flow patterns reflect cardiac function.
- Assessing cardiac function in various cardiac conditions is crucial.
- Pulsed Doppler echocardiography offers a non-invasive method for hemodynamic assessment.
Purpose of the Study:
- To evaluate hepatic venous flow patterns using pulsed Doppler echocardiography.
- To correlate these patterns with cardiac function in patients with diverse cardiac conditions.
- To assess the impact of afterload stress on hepatic venous flow.
Main Methods:
- Pulsed Doppler echocardiography was used to analyze hepatic venous flow in 80 patients and 11 controls.
- Patients included those with dilated cardiomyopathy, myocardial infarction, and atrial fibrillation.
- Afterload stress was induced by angiotensin II infusion in 51 subjects.
Main Results:
- Hepatic venous flow patterns, including systolic/diastolic velocity ratios and "A" and "O" waves, were analyzed.
- Velocity ratios differed significantly between normal sinus rhythm, atrial fibrillation, and post-surgical cases.
- "A" wave velocity correlated with pulmonary artery systolic pressure in pulmonary hypertension.
- Angiotensin II infusion increased the velocity ratio in dilated cardiomyopathy and controls, more pronounced in cardiomyopathy.
Conclusions:
- Pulsed Doppler analysis of hepatic venous flow is valuable for assessing cardiac function.
- Changes in hepatic venous flow patterns, particularly the velocity ratio, reflect atrial and ventricular function.
- A marked increase in the velocity ratio post-angiotensin II infusion suggests compromised cardiac function.
Abstract:
Evaluation of hepatic venous flow patterns was attempted by pulsed Doppler echocardiography. Subjects were 80 patients including those with dilated cardiomyopathy, old myocardial infarction, angina pectoris, pulmonary hypertension, constrictive pericarditis, tricuspid regurgitation (TR), lone atrial fibrillation, and post-cardiac surgery. Eleven normal subjects served as controls. The mean age was 53.0 +/- 12.4 years. Most of the TR patients had atrial fibrillation. Patients with aortic regurgitation and significant mitral regurgitation were excluded. Afterload stress by angiotensin II infusion was performed in 51 subjects, mainly for those with ischemic heart disease, cardiomyopathy and the normal controls. Hepatic venous flow patterns included double-peaked flow signals toward the right atrium, and the relationship between systolic (S) and diastolic flow velocities (D) was expressed as the velocity ratio [S/(S+D)]. A reversed flow during atrial systole was expressed as an "A wave" and that between the S and D waves, as an "O wave". Systolic flow velocity was less than diastolic flow velocity in cases with atrial fibrillation and the post-surgical cases. The velocity ratio was greater than 0.5 in nearly all patients with normal sinus rhythm, and less than 0.5 in cases with atrial fibrillation and the post-surgical cases. In the former, systolic flow velocity was less than diastolic flow velocity after defibrillation, in spite of restoration of normal sinus rhythm. These findings indicate that systolic flow velocity was influenced by atrial relaxation; diastolic flow velocity, by ventricular diastolic function. The A wave was increased in cases with pulmonary hypertension and A wave velocity in the hepatic vein correlated with systolic pulmonary artery pressure. In cases with tricuspid regurgitation, reversed flows were detected during ventricular systole both in normal sinus rhythm and in atrial fibrillation. After infusions of angiotensin II the velocity ratio increased in cases with dilated cardiomyopathy and in normal controls (p less than 0.01). The hepatic venous flow pattern after infusion in the former was characterized by dominant systolic and diminished diastolic flow velocities with a consequent increase in the velocity ratio toward 1.0, while a change in the ratio was less marked in normal controls. In conclusion, analysis of the hepatic venous flow pattern by pulsed Doppler echocardiography is very useful for evaluating cardiac function. A marked increase in the velocity ratio after angiotensin II infusion suggests decreased cardiac function.