title: Recent variceal bleeding: Doppler US hepatic vein waveform in assessment of severity of portal hypertension and vasoactive drug response.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, 162 Ilsan-dong, Wonju 220-701, South Korea. baiksk@medimail.co.kr
authors.forename: Soon Koo
authors.initials: SK
authors.lastname: Baik
authors.forename: Jae Woo
authors.initials: JW
authors.lastname: Kim
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Sang Ok
authors.initials: SO
authors.lastname: Kwon
authors.forename: Young Ju
authors.initials: YJ
authors.lastname: Kim
authors.forename: Joong Wha
authors.initials: JW
authors.lastname: Park
authors.forename: Seong Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Sei Jin
authors.initials: SJ
authors.lastname: Chang
authors.forename: Dong Ki
authors.initials: DK
authors.lastname: Lee
authors.forename: Kwang Hyub
authors.initials: KH
authors.lastname: Han
authors.forename: Soon Ho
authors.initials: SH
authors.lastname: Um
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Lee
mesh_terms: 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
chemical_list: D000959:Antihypertensive Agents; D008236:Lypressin; D000077585:Terlipressin