دورية أكاديمية
Portal vein Doppler tracks volume status in patients with severe tricuspid regurgitation: a proof-of-concept study.
| العنوان: | Portal vein Doppler tracks volume status in patients with severe tricuspid regurgitation: a proof-of-concept study. |
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| المؤلفون: | Alday-Ramírez SM; Department of Echocardiography, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.; Coronary Care Unit, Instituto Nacional de Cardiología 'Ignacio Chávez', Juan Badiano 1, Belisario Domínguez Sección XVI, Tlalpan, 14030 Mexico City, Mexico., Leal-Villarreal MAJ; Coronary Care Unit, Instituto Nacional de Cardiología 'Ignacio Chávez', Juan Badiano 1, Belisario Domínguez Sección XVI, Tlalpan, 14030 Mexico City, Mexico., Gómez-Rodríguez C; Coronary Care Unit, Instituto Nacional de Cardiología 'Ignacio Chávez', Juan Badiano 1, Belisario Domínguez Sección XVI, Tlalpan, 14030 Mexico City, Mexico., Abu-Naeima E; Nephrology Unit, Internal Medicine Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt., Solis-Huerta F; Departamento de Medicina interna, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico., Gamba G; Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.; Molecular Physiology Unit, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico., Baeza-Herrera LA; Department of Echocardiography, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.; Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología 'Ignacio Chávez', Juan Badiano 1, Belisario Domínguez Sección XVI, Tlalpan, 14030 Mexico City, Mexico., Araiza-Garaygordobil D; Coronary Care Unit, Instituto Nacional de Cardiología 'Ignacio Chávez', Juan Badiano 1, Belisario Domínguez Sección XVI, Tlalpan, 14030 Mexico City, Mexico., Argaiz ER; Departamento de Medicina interna, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.; Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico. |
| المصدر: | European heart journal. Acute cardiovascular care [Eur Heart J Acute Cardiovasc Care] 2024 Jul 24; Vol. 13 (7), pp. 570-574. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Oxford University Press Country of Publication: England NLM ID: 101591369 Publication Model: Print Cited Medium: Internet ISSN: 2048-8734 (Electronic) Linking ISSN: 20488726 NLM ISO Abbreviation: Eur Heart J Acute Cardiovasc Care Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2021- : [Oxford] : Oxford University Press Original Publication: London : SAGE Publications, 2012- |
| مواضيع طبية MeSH: | Portal Vein*/diagnostic imaging , Tricuspid Valve Insufficiency*/physiopathology , Tricuspid Valve Insufficiency*/diagnosis , Proof of Concept Study*, Humans ; Male ; Female ; Prospective Studies ; Middle Aged ; Severity of Illness Index ; Aged ; Ultrasonography, Doppler/methods ; Hemodynamics/physiology ; Vena Cava, Inferior/diagnostic imaging |
| مستخلص: | Aims: Renal and liver congestion are associated with adverse outcomes in patients with tricuspid regurgitation (TR). Currently, there are no valid sonographic indicators of fluid status in this population. Intra-renal venous Doppler (IRVD) is a novel method for quantifying renal congestion but its interpretation can be challenging in severe TR due to altered haemodynamics. This study explores the potential of portal vein Doppler (PVD) as an alternative marker for decongestion during volume removal in patients with severe TR. Methods and Results: Forty-two patients with severe TR undergoing decongestive therapy were prospectively enrolled. Inferior vena cava diameter, PVD, and IRVD were sequentially assessed during volume removal. Improvement criteria were portal vein pulsatility fraction (PVPF) < 70% and renal venous stasis index (RVSI) < 0.5 for partial improvement, and PVPF < 30% and RVSI < 0.2 for complete improvement. After volume removal, PVPF significantly improved from 130 ± 39% to 47 ± 44% (P < 0.001), while IRVD improved from 0.72 ± 0.08 to 0.54 ± 0.22 (P < 0.001). A higher proportion of patients displayed improvement in PVD compared to IRVD (partial: 38% vs. 29%, complete: 41% vs. 7%) (P < 0.001). Intra-renal venous Doppler only improved in patients with concomitant improvement in severe TR. Portal vein Doppler was the only predictor of achieving ≥5 L of negative fluid balance [area under the ROC curve (AUC) 0.83 P = 0.001]. Conclusion: This proof-of-concept study suggests that PVD is the only sonographic marker that can track volume removal in severe TR, offering a potential indicator for decongestion in this population. Further intervention trials are warranted to determine if PVD-guided decongestion improves patient outcomes in severe TR. Competing Interests: Conflict of interest: none declared. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.) |
| فهرسة مساهمة: | Keywords: Decongestion; Intra-renal venous Doppler; Portal vein Doppler; Tricuspid regurgitation; VExUS; Venous congestion |
| تواريخ الأحداث: | Date Created: 20240512 Date Completed: 20240723 Latest Revision: 20240723 |
| رمز التحديث: | 20240725 |
| DOI: | 10.1093/ehjacc/zuae057 |
| PMID: | 38734970 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 2048-8734 |
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| DOI: | 10.1093/ehjacc/zuae057 |