Argaiz Eduardo R, Rola Philippe, Gamba Gerardo
Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico,
Division of Intensive Care, Santa Cabrini Hospital, Montreal, Québec, Canada.
Cardiorenal Med. 2021;11(1):59-66. doi: 10.1159/000511714. Epub 2021 Jan 21.
Optimal method for noninvasive assessment of venous congestion remains an unresolved issue. Portal vein (PV) and intrarenal venous flow alterations are markers of abdominal venous congestion and have been associated with acute kidney injury (AKI) in cardiac surgery patients. It is currently unknown if portal vein flow (PVF) alterations in heart failure can be reversed with diuretic treatment and track decongestion.
The aim of this study is to evaluate PVF alterations in patients with ADHF at arrival and after decongestive treatment.
Assessment of venous congestion using point-of-care ultrasound was performed in 12 patients with ADHF (6 patients with left-sided heart failure and 6 patients with right-sided heart failure). Evaluation included inferior vena cava (IVC) size and collapsibility in addition to PV Doppler to determine pulsatility fraction (PF).
Increased PV PF (81.75 ± 13%) was found on admission. After effective decongestive treatment, it improved to (17.43 ± 2.2%). Improvement in IVC size and collapsibility was seen in most patients with left-sided heart failure and none of the patients with right-sided heart failure. Improvement in PV PF coincided with return to baseline of Serum Cr in patients that presented with AKI.
Evaluation of abdominal venous congestion by point-of-care ultrasound could aid in diagnosis and follow-up of patients with congestive kidney injury.
静脉充血的无创评估的最佳方法仍是一个未解决的问题。门静脉（PV）和肾内静脉血流改变是腹部静脉充血的标志物，并与心脏手术患者的急性肾损伤（AKI）相关。目前尚不清楚心力衰竭时门静脉血流（PVF）改变能否通过利尿剂治疗得到逆转并跟踪充血缓解情况。
本研究的目的是评估急性失代偿性心力衰竭（ADHF）患者入院时及充血缓解治疗后的PVF改变。
对12例ADHF患者（6例左心衰竭患者和6例右心衰竭患者）使用床旁超声评估静脉充血情况。评估包括下腔静脉（IVC）大小和可塌陷性，以及PV多普勒以确定搏动分数（PF）。
入院时发现PV PF增加（81.75±13%）。有效充血缓解治疗后，其改善至（17.43±2.2%）。大多数左心衰竭患者的IVC大小和可塌陷性有所改善，而右心衰竭患者均无改善。PV PF的改善与出现AKI患者的血清肌酐恢复至基线水平一致。
床旁超声评估腹部静脉充血情况有助于充血性肾损伤患者的诊断和随访。
