Doppler velocimetry in superior vena cava provides useful information on the right circulatory function in patients with congestive heart failure.
BACKGROUND
Although flow velocities curves recorded with pulsed-wave Doppler in systemic vein are known to provide functional data on the right circulatory function, little information is available on the relationship between right heart filling dynamics and right ventricular function.


METHODS
Consecutive patients with chronic heart failure due to severe systolic left ventricular dysfunction and in sinus rhythm underwent echocardiography and right heart catheterization. In the initial part of the study, the hemodynamic correlates of different flow velocity patterns recorded into the superior vena cava were evaluated in 120 patients. The accuracy of the prediction of different right heart hemodynamic profiles by means of the different venous flow patterns was then prospectively tested in a subsequent series of 86 patients.


RESULTS
The venous flow pattern was closely related to right heart hemodynamics. A normal Doppler pattern identified patients with normal right heart hemodynamics (sensitivity 86%, specificity 78%); a "predominant systolic wave" pattern identified patients with a reduced thermodilution-derived right ventricular ejection fraction (< 30%) and normal or slightly elevated right atrial pressure (< or = 8 mmHg) (sensitivity 69%, specificity 81%); a "predominant diastolic wave" pattern identified patients with a reduced right ventricular ejection fraction (< 3 0%) and elevated right atrial pressure (> 8 mmHg) (sensitivity 52%, specificity 95%). The observed and the predicted hemodynamic profiles turned out to be concordant in 80% of patients.


CONCLUSIONS
The analysis of the flow velocity pattern into the superior vena cava is a useful tool to estimate the extent of the right circulatory impairment in patients with congestive heart failure.
Ghio
S
S
Dipartimento di Cardiologia, Policlinico S Matteo, 27100 Pavia, Italy. s.ghio@smatteo.pv.it
Recusani
F
F
Sebastiani
R
R
Klersy
C
C
Raineri
C
C
Campana
C
C
Lanzarini
L
L
Gavazzi
A
A
Tavazzi
L
L
D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology; D003326:Coronary Circulation / Q000502:physiology*; D015150:Echocardiography, Doppler; D005240:Feasibility Studies; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006439:Hemodynamics / Q000502:physiology; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012212:Rheology; D012680:Sensitivity and Specificity; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging*; D016277:Ventricular Function, Left / Q000502:physiology