门静脉多普勒追踪严重三尖瓣反流患者的血容量状态:概念验证研究

IF 3.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Sergio M Alday-Ramírez, Mario Andrés de Jesús Leal-Villarreal, César Gómez-Rodríguez, Eslam Abu-Naeima, Fernando Solis-Huerta, Gerardo Gamba, Luis A Baeza-Herrera, Diego Araiza-Garaygordobil, Eduardo R Argaiz
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引用次数: 0

摘要

背景:肾脏和肝脏充血与三尖瓣反流(TR)患者的不良预后有关。目前,还没有有效的声学指标来反映这类患者的体液状况。肾静脉内多普勒(IRVD)是一种量化肾充血的新方法,但由于血流动力学的改变,在重度三尖瓣反流患者中解释这种方法具有挑战性。本研究探讨了门静脉多普勒(PVD)作为重度TR患者在排出血容量过程中解除充血的替代标记物的潜力。方法:42 名接受减容治疗的重度 TR 患者接受了前瞻性研究,在抽取容量时依次评估了下腔静脉直径(IVCd)、PVD 和 IRVD。结果:去容量后,PVPF 从 130 ± 39% 显著改善至 47 ± 44%(p 结论:该研究表明,门静脉搏动指数(PVPF)的改善是有意义的:这项概念验证研究表明,PVD 是唯一能跟踪严重 TR 容量去除情况的声像图标记,为这类人群提供了一个潜在的去充血指标。有必要进行进一步的干预试验,以确定 PVD 引导下的减充血是否能改善重度 TR 患者的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Portal vein Doppler tracks volume status in patients with severe tricuspid regurgitation: a proof-of-concept study.

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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来源期刊
CiteScore
8.50
自引率
4.90%
发文量
325
期刊介绍: The European Heart Journal - Acute Cardiovascular Care (EHJ-ACVC) offers a unique integrative approach by combining the expertise of the different sub specialties of cardiology, emergency and intensive care medicine in the management of patients with acute cardiovascular syndromes. Reading through the journal, cardiologists and all other healthcare professionals can access continuous updates that may help them to improve the quality of care and the outcome for patients with acute cardiovascular diseases.
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