Damping index of Doppler hepatic vein waveform to assess the severity of portal hypertension and response to propranolol in liver cirrhosis: a prospective nonrandomized study.
OBJECTIVE
Alterations in the Doppler hepatic vein (HV) waveform are associated with cirrhosis and portal hypertension. We prospectively evaluated the correlation between the extent of abnormal Doppler HV waveforms expressed as damping index (DI) and the hepatic venous pressure gradient (HVPG) and response to propranolol in patients with cirrhosis.


METHODS
In 76 patients with cirrhosis (69 men and seven women), both DI of Doppler HV waveform and HVPG were measured, and the relationship between them was analysed. DI was calculated by the minimum velocity/maximum velocity of the HV waveform. An HVPG>12 mmHg was defined as severe portal hypertension. In a subgroup of 19 patients receiving propranolol, changes in both DI and HVPG were evaluated after propranolol administration for 3 months. One author (S. K. B.) performed all DI of Doppler HV waveform studies.


RESULTS
Abnormal HV waveforms were seen in 66 of 76 patients (86.8%). DI significantly correlated with the grade of HVPG, i.e. with higher HVPG increased DI was observed (P<0.01). By logistic regression analysis, DI>0.6 was significantly more likely to be severe portal hypertension (odds ratio: 14.19, 95% confidence interval: 4.07-49.55). Receiver-operating characteristic curve according to the value of 0.6 of DI showed a sensitivity of 75.9% and a specificity of 81.8% for the presence of severe portal hypertension. In 19 patients of the propranolol subgroup, change of DI following propranolol treatment also significantly correlated with that of HVPG (P<0.01).


CONCLUSIONS
Damping index of the HV waveform by Doppler ultrasonography might be a non-invasive supplementary tool in evaluating the severity of portal hypertension and in responding to propranolol in patients with liver cirrhosis.
Kim
Moon Young
MY
Department of Internal Medicine and Institute of Lifelong Health, Wonju College of Medicine, Yonsei University, Wonju, South Korea.
Baik
Soon Koo
SK
Park
Dong Hun
DH
Lim
Dae Wook
DW
Kim
Jae Woo
JW
Kim
Hyun Soo
HS
Kwon
Sang Ok
SO
Kim
Young Ju
YJ
Chang
Sei Jin
SJ
Lee
Samuel S
SS
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D016014:Linear Models; D008103:Liver Cirrhosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011433:Propranolol / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014690:Venous Pressure / Q000187:drug effects
D000959:Antihypertensive Agents; D011433:Propranolol