Abstract：
OBJECTIVE: Blood flow in the hepatic veins and superior vena cava (SVC) reflects right heart filling; however, their Doppler profiles are often not identical, and no studies have compared their diagnostic efficacies. We aimed to determine which venous Doppler profile is reliable for detecting elevated right atrial pressure (RAP).
METHODS: In 193 patients with cardiovascular diseases who underwent cardiac catheterization within 2 d of echocardiography, the hepatic vein systolic filling fraction (HV-SFF) and the ratio of the peak systolic to diastolic forward velocities of the SVC (SVC-S/D) were measured. HV-SFF < 55% and SVC-S/D < 1.9 were regarded as elevated RAP. We also calculated the fibrosis 4 index (FIB-4) as a serum liver fibrosis marker.
RESULTS: HV-SFF and SVC-S/D were feasible in 177 (92%) and 173 (90%) patients, respectively. In the 161 patients in whom both venous Doppler waveforms could be measured, HV-SFF and SVC-S/D were inversely correlated with RAP (r = -0.350, p < 0.001; r = -0.430, p < 0.001, respectively). SVC-S/D > 1.9 showed a significantly higher diagnostic accuracy of RAP elevation compared with HV-SFF < 55% (area under the curve, 0.842 vs. 0.614, p < 0.001). Multivariate analyses showed that both FIB-4 (β = -0.211, p = 0.013) and mean RAP (β = -0.319, p < 0.001) were independent determinants of HV-SFF. In contrast, not FIB-4 but mean RAP (β = -0.471, p < 0.001) was an independent determinant of SVC-S/D. The diagnostic accuracy remained unchanged when HV-SFF < 55% was considered in conjunction with the estimated RAP based on the inferior vena cava morphology. Conversely, SVC-S/D showed an incremental diagnostic value over the estimated RAP.
CONCLUSIONS: SVC-S/D enabled a more accurate diagnosis of RAP elevation than HV-SFF.
METHODS: In 193 patients with cardiovascular diseases who underwent cardiac catheterization within 2 d of echocardiography, the hepatic vein systolic filling fraction (HV-SFF) and the ratio of the peak systolic to diastolic forward velocities of the SVC (SVC-S/D) were measured. HV-SFF < 55% and SVC-S/D < 1.9 were regarded as elevated RAP. We also calculated the fibrosis 4 index (FIB-4) as a serum liver fibrosis marker.
RESULTS: HV-SFF and SVC-S/D were feasible in 177 (92%) and 173 (90%) patients, respectively. In the 161 patients in whom both venous Doppler waveforms could be measured, HV-SFF and SVC-S/D were inversely correlated with RAP (r = -0.350, p < 0.001; r = -0.430, p < 0.001, respectively). SVC-S/D > 1.9 showed a significantly higher diagnostic accuracy of RAP elevation compared with HV-SFF < 55% (area under the curve, 0.842 vs. 0.614, p < 0.001). Multivariate analyses showed that both FIB-4 (β = -0.211, p = 0.013) and mean RAP (β = -0.319, p < 0.001) were independent determinants of HV-SFF. In contrast, not FIB-4 but mean RAP (β = -0.471, p < 0.001) was an independent determinant of SVC-S/D. The diagnostic accuracy remained unchanged when HV-SFF < 55% was considered in conjunction with the estimated RAP based on the inferior vena cava morphology. Conversely, SVC-S/D showed an incremental diagnostic value over the estimated RAP.
CONCLUSIONS: SVC-S/D enabled a more accurate diagnosis of RAP elevation than HV-SFF.
摘要：
目的：肝静脉和上腔静脉（SVC）的血流反映右心充盈；它们的多普勒轮廓通常不相同，没有研究比较它们的诊断效果。我们旨在确定哪种静脉多普勒曲线可可靠地检测右心房压升高（RAP）。
方法：在超声心动图检查2d内行心导管检查的193例心血管疾病患者中，测量了肝静脉收缩期充盈分数（HV-SFF）和SVC的收缩期峰值与舒张期前向速度之比（SVC-S/D）。HV-SFF<55%和SVC-S/D<1.9被认为是升高的RAP。我们还计算了纤维化4指数(FIB-4)作为血清肝纤维化标志物。
结果：HV-SFF和SVC-S/D在177（92％）和173（90％）患者中可行，分别。在161名患者中，可以测量两个静脉多普勒波形，HV-SFF和SVC-S/D与RAP呈负相关(r=-0.350,p<0.001;r=-0.430,p<0.001)。SVC-S/D>1.9显示，与HV-SFF<55％相比，RAP升高的诊断准确性显着提高（曲线下面积，0.842vs.0.614，p<0.001)。多变量分析表明，FIB-4（β=-0.211，p=0.013）和平均RAP（β=-0.319，p<0.001）是HV-SFF的独立决定因素。相比之下,不是FIB-4，而是平均RAP（β=-0.471，p<0.001）是SVC-S/D的独立决定因素。当HV-SFF<55％与基于下腔静脉形态的估计RAP一起考虑时，诊断准确性保持不变。相反，SVC-S/D显示出比估计的RAP增加的诊断价值。
结论：SVC-S/D能够比HV-SFF更准确地诊断RAP升高。
方法：在超声心动图检查2d内行心导管检查的193例心血管疾病患者中，测量了肝静脉收缩期充盈分数（HV-SFF）和SVC的收缩期峰值与舒张期前向速度之比（SVC-S/D）。HV-SFF<55%和SVC-S/D<1.9被认为是升高的RAP。我们还计算了纤维化4指数(FIB-4)作为血清肝纤维化标志物。
结果：HV-SFF和SVC-S/D在177（92％）和173（90％）患者中可行，分别。在161名患者中，可以测量两个静脉多普勒波形，HV-SFF和SVC-S/D与RAP呈负相关(r=-0.350,p<0.001;r=-0.430,p<0.001)。SVC-S/D>1.9显示，与HV-SFF<55％相比，RAP升高的诊断准确性显着提高（曲线下面积，0.842vs.0.614，p<0.001)。多变量分析表明，FIB-4（β=-0.211，p=0.013）和平均RAP（β=-0.319，p<0.001）是HV-SFF的独立决定因素。相比之下,不是FIB-4，而是平均RAP（β=-0.471，p<0.001）是SVC-S/D的独立决定因素。当HV-SFF<55％与基于下腔静脉形态的估计RAP一起考虑时，诊断准确性保持不变。相反，SVC-S/D显示出比估计的RAP增加的诊断价值。
结论：SVC-S/D能够比HV-SFF更准确地诊断RAP升高。
