Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Nov 26, 2023; 15(11): 599-608
Published online Nov 26, 2023. doi: 10.4330/wjc.v15.i11.599
Clinical impact of portal vein pulsatility on the prognosis of hospitalized patients with acute heart failure
Naoya Kuwahara, Tomoyuki Honjo, Naohiko Sone, Junichi Imanishi, Kazuhiko Nakayama, Kohei Kamemura, Masanori Iwahashi, Soichiro Ohta, Kenji Kaihotsu
Naoya Kuwahara, Tomoyuki Honjo, Naohiko Sone, Junichi Imanishi, Kazuhiko Nakayama, Kohei Kamemura, Masanori Iwahashi, Soichiro Ohta, Kenji Kaihotsu, Department of Cardiology, Shinko Hospital, Kobe 651-0072, Japan
Author contributions: Honjo T, Sone N, and Kaihotsu K substantially contributed to the study conceptualization; Kuwahara N and Honjo T substantially contributed to data analysis and interpretation; Honjo T substantially contributed to the manuscript drafting; all authors critically reviewed and revised the manuscript draft and approved the final version for submission.
Institutional review board statement: This study was reviewed and approved by the ethics committee of Shinko Hospital (approval No. 1524).
Informed consent statement: This study was approved by the Institutional Review Board of Shinko Hospital, and all requirements for written informed consent were waived for the use of the patients’ clinical and imaging data.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tomoyuki Honjo, MD, PhD, Doctor, Department of Cardiology, Shinko Hospital, 1-4-47, Wakinohamacho, Chuo-ku, Kobe 651-0072, Japan. thonjo@honjo-iin.com
Received: July 5, 2023
Peer-review started: July 5, 2023
First decision: August 31, 2023
Revised: September 12, 2023
Accepted: November 2, 2023
Article in press: November 2, 2023
Published online: November 26, 2023
Processing time: 141 Days and 3.9 Hours
ARTICLE HIGHLIGHTS
Research background

Heart failure (HF) causes extracardiac organ congestion, including in the hepatic portal system. Reducing venous congestion is essential for HF treatment, but evaluating venous congestion is sometimes difficult in patients with chronic HF.

Research motivation

The portal vein (PV) flow pattern can be influenced by right atrial pressure. Ultrasound images of the PV are quite easy to obtain and are reproducible among sonographers. However, the association between PV pulsatility and the condition of HF remains unclear. We hypothesize that PV pulsatility at discharge reflects the condition of HF.

Research objectives

To evaluate the usefulness of PV pulsatility as a prognostic marker for hospitalized patients with acute HF.

Research methods

This observational study was conducted from April 2016 to January 2017 and April 2018 to April 2019 at Shinko Hospital. We enrolled 56 patients with acute HF, and 17 patients without HF served as controls. PV flow velocity was measured by ultrasonography on admission and at discharge. We calculated the PV pulsatility ratio (PVPR) as the ratio of the difference between the peak and minimum velocity to the peak velocity. The primary endpoint was cardiac death and HF re-hospitalization. The observation period was 1 year from the first hospitalization. The Kaplan-Meier method was used to determine the stratified composite event-free rates, and the log-rank test was used for comparisons between groups.

Research results

On admission, the PVPR was significantly higher in patients with acute HF than controls (HF: 0.29 ± 0.20 vs controls: 0.08 ± 0.07, P < 0.01). However, the PVPR was significantly decreased after the improvement in HF (admission: 0.29 ± 0.20 vs discharge: 0.18 ± 0.15, P < 0.01) due to the increase in minimum velocity (admission: 12.6 ± 4.5 vs discharge: 14.6 ± 4.6 cm/s, P = 0.03). To elucidate the association between the PVPR and cardiovascular outcomes, the patients were divided into three groups according to the PVPR tertile at discharge (PVPR-T1: 0 ≤ PVPR ≤ 0.08, PVPR-T2: 0.08 < PVPR ≤ 0.21, PVPR-T3: PVPR > 0.21). The Kaplan–Meier analysis showed that patients with a higher PVPR at discharge had the worst prognosis among the groups.

Research conclusions

The PVPR at discharge reflects the condition of HF.

Research perspectives

The PVPR is also a novel prognostic marker for hospitalized patients with acute HF.