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Portal vein Doppler tracks volume status in patients with severe tricuspid regurgitation: a proof-of-concept study.
Alday-Ramírez, Sergio M; Leal-Villarreal, Mario Andrés de Jesús; Gómez-Rodríguez, César; Abu-Naeima, Eslam; Solis-Huerta, Fernando; Gamba, Gerardo; Baeza-Herrera, Luis A; Araiza-Garaygordobil, Diego; Argaiz, Eduardo R.
Afiliação
  • Alday-Ramírez SM; Department of Echocardiography, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 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; Coronary Care Unit, Instituto Nacional de Cardiología 'Ignacio Chávez', Juan Badiano 1, Belisario Domínguez Sección XVI, Tlalpan, 14030 Mexico City, Mexico.
  • Solis-Huerta F; Nephrology Unit, Internal Medicine Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt.
  • Gamba G; Departamento de Medicina interna, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
  • Baeza-Herrera LA; Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
  • Araiza-Garaygordobil D; 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.
  • Argaiz ER; Department of Echocardiography, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Eur Heart J Acute Cardiovasc Care ; 13(7): 570-574, 2024 Jul 24.
Article em En | MEDLINE | ID: mdl-38734970
ABSTRACT

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.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Veia Porta / Insuficiência da Valva Tricúspide / Estudo de Prova de Conceito Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Eur Heart J Acute Cardiovasc Care Ano de publicação: 2024 Tipo de documento: Article País de afiliação: México País de publicação: Reino Unido
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Veia Porta / Insuficiência da Valva Tricúspide / Estudo de Prova de Conceito Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Eur Heart J Acute Cardiovasc Care Ano de publicação: 2024 Tipo de documento: Article País de afiliação: México País de publicação: Reino Unido