Grigore Mihai, Grigore Andreea-Maria, Ilieșiu Adriana-Mihaela
Internal Medicine and Cardiology Department, Carol Davila University of Medicine and Pharmacy, "Prof. Dr. Theodor Burghele" Clinical Hospital, 020021 Bucharest, Romania.
Carol Davila University of Medicine and Pharmacy, Cardiology Department Colentina Clinical Hospital, 020021 Bucharest, Romania.
Diagnostics (Basel). 2024 Sep 13;14(18):2029. doi: 10.3390/diagnostics14182029.
The severity of systemic congestion is associated with increased portal vein flow pulsatility (PVP).
To determine the usefulness of PVP as a marker of decongestion and prognosis in acute decompensated heart failure (ADHF) patients.
105 patients, 60% of whom were men, were hospitalized with ADHF, and their PVP index (PVPI) was calculated (maximum velocity-minimum velocity/maximum velocity) × 100 on admission and before discharge, along with their EVEREST score, inferior vena cava diameter (IVC), NT-proBNP, serum sodium, and glomerular filtration rate. A PVPI ≥ 50% was defined as a marker of systemic congestion. After treatment with loop diuretics, a decrease in PVPI of >50% before discharge was considered a marker of decongestion The patients were classified into two groups (G): G1-PVPI decrease ≥ 50% (54 patients) and G2-PVPI decrease < 50% (51 patients).
At discharge, compared to G2, G1 patients had lower mean PVPI (14.2 vs. 38.9; < 0.001), higher serum Na (138 vs. 132 mmol/L, = 0.03), and a higher number of patients with a significant (>30%) NT-proBNP decrease (42 vs. 27, = 0.007). PVPI correlated with IVC (r = 0.55, < 0.001), NT-proBNP (r = 0.21, = 0.04), and serum Na (r = -0.202, = 0.04). A total of 55% of patients had worsening renal failure (G1 63% vs. G2 48%, = 0.17). After 90 days, G2 patients had higher mortality (27.45% vs. 3.7 = 0.001) and rehospitalization (49.01% vs. 33.33%, < 0.001). In multivariate regression analysis, PVPI was an independent predictor of rehospitalization (OR 1.05, 95% CI 1.00-1.10, = 0.048).
Portal vein flow pulsatility, a meaningful marker of persistent subclinical congestion, is related to short-term prognosis in ADHF patients.
全身充血的严重程度与门静脉血流搏动性（PVP）增加有关。
确定PVP作为急性失代偿性心力衰竭（ADHF）患者充血缓解和预后标志物的效用。
105例因ADHF住院的患者，其中60%为男性，在入院时和出院前计算其PVP指数（PVPI）[（最大速度-最小速度）/最大速度]×100，同时计算其EVEREST评分、下腔静脉直径（IVC）、N末端脑钠肽前体（NT-proBNP）、血清钠和肾小球滤过率。PVPI≥50%被定义为全身充血的标志物。在使用袢利尿剂治疗后，出院前PVPI下降>50%被认为是充血缓解的标志物。患者被分为两组（G）：G1组-PVPI下降≥50%（54例患者）和G2组-PVPI下降<50%（51例患者）。
出院时，与G2组相比，G1组患者的平均PVPI较低（14.2对38.9；<0.001），血清钠较高（138对132 mmol/L，=0.03），NT-proBNP显著下降（>30%）的患者数量较多（42对27，=0.007）。PVPI与IVC（r = 0.55，<0.001）、NT-proBNP（r = 0.21，=0.04）和血清钠（r = -0.202，=0.04）相关。共有55%的患者出现肾功能恶化（G1组63%对G2组48%，=0.17）。90天后，G2组患者的死亡率较高（27.45%对3.7%，=0.001）和再住院率较高（49.01%对33.33%，<0.001）。在多因素回归分析中，PVPI是再住院的独立预测因素（比值比1.05，95%可信区间1.00-1.10，=0.048）。
门静脉血流搏动性是持续亚临床充血的一个有意义的标志物，与ADHF患者的短期预后相关。
