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Abstract：
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.
OBJECTIVE: 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.
CONCLUSIONS: PVPR at discharge reflects the condition of HF. It is also a novel prognostic marker for hospitalized patients with acute HF.
OBJECTIVE: 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.
CONCLUSIONS: PVPR at discharge reflects the condition of HF. It is also a novel prognostic marker for hospitalized patients with acute HF.
摘要：
背景：心力衰竭（HF）导致心外器官充血，包括肝门系统。减少静脉充血对HF治疗至关重要,但是在慢性HF患者中,评估静脉充血有时是困难的.门静脉（PV）血流模式可能受到右心房压力的影响。PV的超声图像很容易获得，并且在超声医师中可以重现。然而,肺静脉搏动性与HF状况之间的关联尚不清楚.我们假设放电时的PV脉动反映了HF的状况。
目的：评估肺静脉搏动作为急性HF住院患者预后指标的有效性。
方法：本观察性研究于2016年4月至2017年1月和2018年4月至2019年4月在新科医院进行。我们纳入了56例急性HF患者，17例无HF患者作为对照。在入院和出院时通过超声检查测量PV流速。我们将PV脉动比（PVPR）计算为峰值和最小速度之差与峰值速度之比。主要终点是心源性死亡和HF再住院。观察期为从第一次住院起1年。Kaplan-Meier方法用于确定分层复合无事件率，组间比较采用对数秩检验.
结果：入学时，急性HF患者的PVPR明显高于对照组（HF：0.29±0.20vs对照组：0.08±0.07，P<0.01）。然而,由于最小速度的增加（入院：12.6±4.5vs出院：14.6±4.6cm/s），HF改善后PVPR显着降低（入院：0.29±0.20vs出院：0.18±0.15，P<0.01），P=0.03)。为了阐明PVPR与心血管结局之间的关系，根据出院时的PVPR三分法将患者分为三组(PVPR-T1:0≤PVPR≤0.08,PVPR-T2:0.080.21).Kaplan-Meier分析显示，出院时PVPR较高的患者预后最差。
结论：出院时的PVPR反映了HF的状况。它也是急性HF住院患者的新型预后标志物。
目的：评估肺静脉搏动作为急性HF住院患者预后指标的有效性。
方法：本观察性研究于2016年4月至2017年1月和2018年4月至2019年4月在新科医院进行。我们纳入了56例急性HF患者，17例无HF患者作为对照。在入院和出院时通过超声检查测量PV流速。我们将PV脉动比（PVPR）计算为峰值和最小速度之差与峰值速度之比。主要终点是心源性死亡和HF再住院。观察期为从第一次住院起1年。Kaplan-Meier方法用于确定分层复合无事件率，组间比较采用对数秩检验.
结果：入学时，急性HF患者的PVPR明显高于对照组（HF：0.29±0.20vs对照组：0.08±0.07，P<0.01）。然而,由于最小速度的增加（入院：12.6±4.5vs出院：14.6±4.6cm/s），HF改善后PVPR显着降低（入院：0.29±0.20vs出院：0.18±0.15，P<0.01），P=0.03)。为了阐明PVPR与心血管结局之间的关系，根据出院时的PVPR三分法将患者分为三组(PVPR-T1:0≤PVPR≤0.08,PVPR-T2:0.08
结论：出院时的PVPR反映了HF的状况。它也是急性HF住院患者的新型预后标志物。
