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Recent variceal bleeding: Doppler US hepatic vein waveform in assessment of severity of portal hypertension and vasoactive drug response

 Soon Koo Baik  ;  Jae Woo Kim  ;  Hyun Soo Kim  ;  Sang Ok Kwon  ;  Young Ju Kim  ;  Joong Wha Park  ;  Seong Hyun Kim  ;  Sei Jin Chang  ;  Dong Ki Lee  ;  Kwang Hyub Han  ;  Soon Ho Um  ;  Samuel S. Lee 
 RADIOLOGY, Vol.240(2) : 574-580, 2006 
Journal Title
Issue Date
Antihypertensive Agents/therapeutic use ; Esophageal and Gastric Varices/complications ; Esophageal and Gastric Varices/diagnostic imaging* ; Esophageal and Gastric Varices/physiopathology ; Female ; Hepatic Veins/diagnostic imaging ; Humans ; Hypertension, Portal/diagnostic imaging* ; Hypertension, Portal/drug therapy ; Hypertension, Portal/etiology ; Hypertension, Portal/physiopathology ; Liver Cirrhosis/complications ; Liver Cirrhosis/diagnostic imaging ; Liver Cirrhosis/physiopathology ; Logistic Models ; Lypressin/analogs & derivatives ; Lypressin/therapeutic use ; Male ; Middle Aged ; Monitoring, Physiologic ; Portal Pressure ; Prognosis ; Prospective Studies ; Sensitivity and Specificity ; Terlipressin ; Ultrasonography, Doppler*
PURPOSE: To prospectively evaluate both the correlation between abnormal Doppler ultrasonography (US) hepatic vein waveforms and the hepatic venous pressure gradient (HVPG) and the response to drug treatment in patients with cirrhosis.
MATERIALS AND METHODS: Ethics committee approval and informed consent of patients and control subjects were obtained. In 78 patients with cirrhosis (70 men, eight women; mean age, 49.4 years +/- 9.7 [standard deviation]) and a history of variceal bleeding, both the hepatic vein waveform--as measured with Doppler US--and the HVPG were measured, and the relationship between them was analyzed. Hepatic vein Doppler waveforms were classified as triphasic, biphasic, or monophasic. Severe portal hypertension was defined as an HVPG of more than 15 mm Hg. In a subgroup of 21 patients, changes in hepatic vein waveform and HVPG were evaluated after intravenous administration of 2 mg of terlipressin. Statistical analyses were performed with Spearman rank correlation, logistic regression analysis, and cross tabulation.
RESULTS: Abnormal hepatic vein waveforms were seen in 72 patients (92%). Forty-four patients (56%) had biphasic waveforms, 28 (36%) had monophasic waveforms, and six (8%) had triphasic waveforms. A positive correlation was found between the extent of abnormalities in hepatic vein waveforms and the increase in HVPG (P < .05). Monophasic waveforms were associated with severe portal hypertension, with a sensitivity of 74% and a specificity of 95%. Twenty patients in the terlipressin subgroup had abnormal baseline waveforms; the baseline waveform improved in 18 patients in association with the HVPG reduction after injection of terlipressin.
CONCLUSION: Doppler US hepatic vein waveform assessment is useful in the noninvasive evaluation of the severity of portal hypertension and the response to vasoactive drugs in patients with portal hypertension and variceal bleeding.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Lee, Dong Ki(이동기) ORCID logo https://orcid.org/0000-0002-0048-9112
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
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