Liver Congestion Assessed by Hepatic Vein Waveforms in Patients With Heart Failure

• Published in: CJC open (Online) 2021-06, Vol.3 (6), p.778-786
• Main Authors: Sugawara, Yukiko, Yoshihisa, Akiomi, Ishibashi, Shinji, Matsuda, Mitsuko, Yamadera, Yukio, Ohara, Himika, Ichijo, Yasuhiro, Watanabe, Koichiro, Hotsuki, Yu, Anzai, Fumiya, Sato, Yu, Kimishima, Yusuke, Yokokawa, Tetsuro, Misaka, Tomofumi, Yamada, Shinya, Sato, Takamasa, Kaneshiro, Takashi, Oikawa, Masayoshi, Kobayashi, Atsushi, Takeishi, Yasuchika
• Format: Article
• Language: English
• Subjects: Original
• ISSN: 2589-790X; 2589-790X
• DOI: 10.1016/j.cjco.2021.02.004

It has been reported that the pattern of hepatic vein (HV) waveforms determined by abdominal ultrasonography is useful for the diagnosis of hepatic fibrosis in patients with chronic liver disease. We aim to clarify the clinical implications of HV waveform patterns in patients with heart failure (HF). We measured HV waveforms in 350 HF patients, who were then classified into 3 categories based on their waveforms: those with a continuous pattern (C group); those whose V wave ran under the baseline (U group), and those with a reversed V wave (R group). We performed right-heart catheterization, and examined the rate of postdischarge cardiac events, such as cardiac death and rehospitalization due to worsening HF. The number of patients in each of the 3 HV waveform groups was as follows: C group, n = 158; U group, n = 152, and R group, n = 40. The levels of B-type natriuretic peptide (R vs C and U; 245.8 vs 111.7 and 216.6 pg/mL; P < 0.01) and mean right atrial pressure (10.5 vs 6.7 and 7.2 mm Hg; P < 0.01) were highest in the R group compared with the other groups. The Kaplan-Meier analysis found that cardiac event–free rates were lowest in the R group among all groups (log-rank P < 0.001). In the multivariable Cox proportional hazard analysis, the R group was found to be an independent predictor of cardiac events (hazard ratio, 4.90; 95% confidence interval, 2.23-10.74; P < 0.01). Among HF patients, those with reversed V waves had higher right atrial pressure and were at higher risk of adverse prognosis. Nous avons appris que le tracé ondulatoire de la veine hépatique (VH) à l’échographie abdominale est utile au diagnostic de la fibrose hépatique chez les patients atteints d’une maladie chronique du foie. Nous avons pour objectif de clarifier les implications cliniques des tracés ondulatoires de la VH chez les patients atteints d’insuffisance cardiaque (IC). Nous avons mesuré les ondulations de la VH de 350 patients atteints d’IC et les avons ensuite classifiés en trois catégories selon leurs ondulations : ceux qui avaient un tracé continu (groupe C); ceux dont l’onde V se présentait selon les valeurs de référence (groupe U); ceux qui avaient une onde V inversée (groupe R). Nous avons réalisé un cathétérisme cardiaque droit et examiné le taux d’événements cardiaques après la sortie de l’hôpital tels que la mort d’origine cardiaque et la réhospitalisation en raison de l’aggravation de l’IC. Le nombre de patients dans chacun des trois groupes d’ondulations de la