Color Doppler velocity profile assessment of portal hemodynamics in cirrhotic patients with portal hypertension: Correlation with esophageal varicealbleeding

Purpose. Using the color Doppler velocity profile (CDVP), we investigated p ortal hemodynamics and their relationship with esophageal variceal bleeding (EVB) in patients with cirrhosis and portal hypertension. Methods. The hemodynamics of the portal trunk, right anterior portal branch , and splenic vein were evaluated in 69 cirrhotic patients with portal hype rtension and 46 healthy volunteers. The CDVP, a recently developed Doppler software, was used to measure blood flow velocity and flow volume; evaluate the spatial distribution of flow velocities in the cross-section of a vess el (velocity profile), as reflected by the profile parameter (n); and asses s changes in flow volume over time (flow profile). The congestion index was calculated by dividing the cross-sectional area by the maximum cross-secti onal velocity (CSVmax). The hemodynamic features were compared between pati ents without a history of EVE [EVE(-)] and those with a history of EVE [EVB (+)], and a logistic regression model was employed to identify factors asso ciated with EVE. Results. Compared with the healthy group, the cirrhotic group had a signifi cantly lower mean CSVmax in the portal trunk and right anterior portal bran ch (both p < 0.01), a significantly elevated mean flow volume in the spleni c vein and portal trunk (both p < 0.01), a significantly elevated mean rati o of splenic vein flow volume to portal trunk flow volume (SV/PT) (p < 0.00 1), and a significantly greater mean congestion index in the portal trunk, right anterior portal branch, and splenic vein (ali p < 0.01). In the cirrh otic group, there was a significantly higher incidence of a flat flow patte rn in the right anterior portal branch and a phasic flow pattern in the spl enic vein than in the healthy group (both p < 0.01). Among cirrhotic patien ts, the EVB(+) group had a significantly greater mean flow volume in the sp lenic vein (p < 0.01), greater mean SV/PT (p < 0.01), greater mean spleen s ize (p < 0.05), and lower mean portal trunk n value (p < 0.05) compared wit h the EVE(-) group. Logistic regression analysis revealed that the SV/PT an d portal trunk n value were independent EVE-related factors. Conclusions. The results suggest that portal hemodynamics in cirrhotic pati ents are characterized by passive congestion and increased blood flow. Howe ver, these 2 features had different preponderances in different parts of th e portal venous system. Increased flow in the splenic vein may be the prima ry source of increased portal flow and may play a role in the development o f EVE. The SV/PT and portal trunk n value may be valuable factors for predi cting EVE. (C) 2000 John Wiley & Sons, Inc.