Recent variceal bleeding: Doppler US hepatic vein waveform in assessment of severity of portal hypertension and vasoactive drug response.
OBJECTIVE
To prospectively evaluate both the correlation between abnormal Doppler ultrasonography (US) hepatic vein waveforms and the hepatic venous pressure gradient (HVPG) and the response to drug treatment in patients with cirrhosis.


METHODS
Ethics committee approval and informed consent of patients and control subjects were obtained. In 78 patients with cirrhosis (70 men, eight women; mean age, 49.4 years +/- 9.7 [standard deviation]) and a history of variceal bleeding, both the hepatic vein waveform--as measured with Doppler US--and the HVPG were measured, and the relationship between them was analyzed. Hepatic vein Doppler waveforms were classified as triphasic, biphasic, or monophasic. Severe portal hypertension was defined as an HVPG of more than 15 mm Hg. In a subgroup of 21 patients, changes in hepatic vein waveform and HVPG were evaluated after intravenous administration of 2 mg of terlipressin. Statistical analyses were performed with Spearman rank correlation, logistic regression analysis, and cross tabulation.


RESULTS
Abnormal hepatic vein waveforms were seen in 72 patients (92%). Forty-four patients (56%) had biphasic waveforms, 28 (36%) had monophasic waveforms, and six (8%) had triphasic waveforms. A positive correlation was found between the extent of abnormalities in hepatic vein waveforms and the increase in HVPG (P < .05). Monophasic waveforms were associated with severe portal hypertension, with a sensitivity of 74% and a specificity of 95%. Twenty patients in the terlipressin subgroup had abnormal baseline waveforms; the baseline waveform improved in 18 patients in association with the HVPG reduction after injection of terlipressin.


CONCLUSIONS
Doppler US hepatic vein waveform assessment is useful in the noninvasive evaluation of the severity of portal hypertension and the response to vasoactive drugs in patients with portal hypertension and variceal bleeding.
Baik
Soon Koo
SK
Department of Internal Medicine, Yonsei University Wonju College of Medicine, 162 Ilsan-dong, Wonju 220-701, South Korea. baiksk@medimail.co.kr
Kim
Jae Woo
JW
Kim
Hyun Soo
HS
Kwon
Sang Ok
SO
Kim
Young Ju
YJ
Park
Joong Wha
JW
Kim
Seong Hyun
SH
Chang
Sei Jin
SJ
Lee
Dong Ki
DK
Han
Kwang Hyub
KH
Um
Soon Ho
SH
Lee
Samuel S
SS
D000959:Antihypertensive Agents / Q000627:therapeutic use; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D016015:Logistic Models; D008236:Lypressin / Q000031:analogs & derivatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D017082:Portal Pressure; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D000077585:Terlipressin; D018608:Ultrasonography, Doppler
D000959:Antihypertensive Agents; D008236:Lypressin; D000077585:Terlipressin