Changes of portal flow in heart failure patients with liver congestion

The goal of the study was to describe the changes of the portal vein (PV) flow in patients with an exacerbation of advanced chronic congestion heart failure (CHF) in relation to central hemodynamics and biochemical indicators of liver lesion. 90 pts (76 males) aged 49.2 +/- 11.2 years admitted for an acute exacerbation of chronic heart failure based on severe left ventricular systolic dysfunction (LVEF 20 +/- 4.3%) were evaluated. The PV flow was sampled from the main portal vein using the intercostal approach. Systolic and diastolic flow velocities were measured and the the pulsatility index (PI, max - min/max PV flow velocity) was calculated. The median of PI in all patients was 0.82 (0-2.0). PI > or = 0.5 was found in 77 (86%) of patients. There was a significant linear correlation of PI and right atrium pressure (RAP), pulmonary vascular resistance (PVR) and mean pulmonary artery pressure (mPAP) (p or =8 mmHg, 67 (89%) had the pulsatility index > or = 0.5. The mean RAP was 7.2 +/- 3.1 mmHg in patients with continuous flow, 14.9 +/- 5.9 mmHg in the group with pulsatile flow pattern, and 20.1 +/- 6.3 and 21.1 +/- 6.5 mmHg in intermittent and alternating flow, respectively (p < 0.01). The flow pulsatility increases with increasing right ventricular filling pressure so that an analysis of the PV flow can detect the elevation of right atrial pressure and allow a quantitative estimation of RAP. The finding of flat portal vein flow wave patterns in HF patients with signs of congestion draws the attention to concurrent primary liver disease. This information could be important in the risk stratification as well as in the therapeutic decision (Tab. 1, Fig. 6, Ref. 19).