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Clinical impact of portal vein pulsatility on the prognosis of hospitalized patients with acute heart failure

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 influen...

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Autores principales: Kuwahara, Naoya, Honjo, Tomoyuki, Sone, Naohiko, Imanishi, Junichi, Nakayama, Kazuhiko, Kamemura, Kohei, Iwahashi, Masanori, Ohta, Soichiro, Kaihotsu, Kenji
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2023
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10696205/
http://dx.doi.org/10.4330/wjc.v15.i11.599
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author Kuwahara, Naoya
Honjo, Tomoyuki
Sone, Naohiko
Imanishi, Junichi
Nakayama, Kazuhiko
Kamemura, Kohei
Iwahashi, Masanori
Ohta, Soichiro
Kaihotsu, Kenji
author_facet Kuwahara, Naoya
Honjo, Tomoyuki
Sone, Naohiko
Imanishi, Junichi
Nakayama, Kazuhiko
Kamemura, Kohei
Iwahashi, Masanori
Ohta, Soichiro
Kaihotsu, Kenji
author_sort Kuwahara, Naoya
collection PubMed
description 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.
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spelling pubmed-106962052023-12-06 Clinical impact of portal vein pulsatility on the prognosis of hospitalized patients with acute heart failure Kuwahara, Naoya Honjo, Tomoyuki Sone, Naohiko Imanishi, Junichi Nakayama, Kazuhiko Kamemura, Kohei Iwahashi, Masanori Ohta, Soichiro Kaihotsu, Kenji World J Cardiol Observational Study 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. Baishideng Publishing Group Inc 2023-11-26 2023-11-26 /pmc/articles/PMC10696205/ http://dx.doi.org/10.4330/wjc.v15.i11.599 Text en ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/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/
spellingShingle Observational Study
Kuwahara, Naoya
Honjo, Tomoyuki
Sone, Naohiko
Imanishi, Junichi
Nakayama, Kazuhiko
Kamemura, Kohei
Iwahashi, Masanori
Ohta, Soichiro
Kaihotsu, Kenji
Clinical impact of portal vein pulsatility on the prognosis of hospitalized patients with acute heart failure
title Clinical impact of portal vein pulsatility on the prognosis of hospitalized patients with acute heart failure
title_full Clinical impact of portal vein pulsatility on the prognosis of hospitalized patients with acute heart failure
title_fullStr Clinical impact of portal vein pulsatility on the prognosis of hospitalized patients with acute heart failure
title_full_unstemmed Clinical impact of portal vein pulsatility on the prognosis of hospitalized patients with acute heart failure
title_short Clinical impact of portal vein pulsatility on the prognosis of hospitalized patients with acute heart failure
title_sort clinical impact of portal vein pulsatility on the prognosis of hospitalized patients with acute heart failure
topic Observational Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10696205/
http://dx.doi.org/10.4330/wjc.v15.i11.599
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