Portal hemodynamics in cirrhotics with portal hypertension using color Doppler velocity profile

Objective To investigate portal hemodynamics and its correlation with esoph ageal variceal bleeding (EVB) in cirrhotics with portal hypertension by usi ng a newly-developed technique, color Doppler velocity profile (CDVP). Methods Hemodynamics of portal trunk (PT), right anterior branch (RAB) and splenic vein (SV) were evaluated in 48 cirrhotics with portal hypertension and 35 normal volunteers by CDVP. The parameters included maximum cross-sec tional velocity (CS-Vmax), flow volume, congestion index (CI), profile para meter N and pattern of flow curve. Stepwise logistic regression model was e mployed to determine EVB-relating factors in cirrhotics. Results CS-Vmax in PT and RAB was significantly tower in cirrhotic group th an that of normal group, being 14.91 +/- 3.08 cm/s, 9.44 +/- 2.70 cm/s vs 3 0.52 +/- 6.75 cm/s, 12.82 +/- 2.69 cm/s, respectively (P < 0.01 for both). Flow volume of PT and SV was significantly higher in cirrhotic group compar ed with that of normal group, being 25.16 +/- 10.48 ml.min(-1).kg(-1), 15.8 3 +/- 9.18 ml.min(-1).kg(-1) vs 20.43 +/- 5.57 ml.min(-1).kg(-1), 5.81 +/- 2.04 ml.min(-1).kg(-1), respectively (P < 0.01 for both). CI of PT, RAB and SV was significantly higher in cirrhotic group than in normal group, being 0.142 +/- 0.0 654, 0.105 +/- 0.0 496, 0.0 884 +/- 0.0 431 vs 0.0 326 +/- 0 .0 142, 0.0757 +/- 0.0 342, 0.0 483 +/- 0.0230, respectively (P < 0.01 for all). In dynamic variation of flow volume over time, RAB and SV in cirrhoti c group increasingly presented flat pattern and periodically changed patter n, respectively (P < 0.01 for both). Between cirrhotic subgroups without an d with EVB history, there were significant differences in flow volume, Ci a nd N value of SV, splenic size, degree of esophageal varices (EV) and porta l hypertensive gastropathy (PHG), and stepwise logistic regression revealed that N value of SV, splenic size, degree of Ri and PHG were four independe nt factors in relation to EVB. EVB scores calculated from the regression eq uation had a close correlation with EVB. In patients with EVB score > 0, 88 .9% of them had EVB, and in those with EVB < 0, 76.9% of them had no histor y of EVB. Conclusion In cirrhotics with portal hypertension, portal venous system has the features of elevated vascular resistance and hyperdynamics, and the la tter mainly results from increased blood flow in SV. EVB score may become a valuable parameter in predicting occurrence of EVB.