PORTAL-VEIN PULSATILITY RATIO AND HEART-FAILURE

Purpose. Heart diseases can alter liver volume, morphology, and circul ation. The Doppler pulsatility of the portal vein and its pulsatility ratio (PR) have been reported as being closely associated with the rig ht atrial pressure and with the New York Heart Association (NYHA) clas s. We examined the relationships between measurements of liver and spl een dimensions and blood flow in portal and hepatic veins, assessed no ninvasively by Doppler sonography, and compared them with echocardiogr aphic data. Methods. The study group comprised 87 inpatients with hear t failure. The mean age was 64 +/- 12 years. Patients underwent duplex Doppler sonography of the heart and portal and hepatic veins. Results . Patients with more severe left ventricular failure (NYHA class III-I V) showed more dilatation of the left ventricle and atrium, reduced sy stolic function, and reduced portal vein mean velocity compared with p atients with milder heart failure (NYHA class I-II); in addition, the hepatic vein diameter was increased and portal vein PR was reduced. Co nsidering all patients, significant positive correlations were found b etween portal vein PR and left ventricular shortening fraction (r = 0. 34, p < 0.01) and ejection fraction (r = 0.38, p < 0.001). Significant negative correlations were found between PR and hepatic vein diameter (r = -0.44, p < 0.001), right ventricle diameter (r = -0.38, p < 0.00 1), left ventricular end-diastolic volume (r = -0.31, p < 0.01), and l eft atrium diameter (r = -0.33, p < 0.01). Patients with hepatic vein dilatation had increased left ventricular volumes, reduced systolic fu nction indices, and portal vein alterations (increased diameter, reduc ed mean velocity, and reduced PR). In patients with an ejection fracti on of no more than 50%, only PR was significantly reduced, while other sonographic liver measurements were not significantly different. Conc lusions. The effects of cardiac failure on portal blood flow, which de clines progressively with worsening cardiac function, is shown better by the pulsatility pattern of the portal vein than by morphologic cava l and hepatic vein measurements. PR can be used as a reliable adjuncti ve sign of heart failure. (C) 1998 John Wiley & Sons, Inc.