title: 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.
abstract: 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.
authors.affiliation: Department of Internal Medicine and Institute of Lifelong Health, Wonju College of Medicine, Yonsei University, Wonju, South Korea.
authors.forename: Moon Young
authors.initials: MY
authors.lastname: Kim
authors.forename: Soon Koo
authors.initials: SK
authors.lastname: Baik
authors.forename: Dong Hun
authors.initials: DH
authors.lastname: Park
authors.forename: Dae Wook
authors.initials: DW
authors.lastname: Lim
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: Sei Jin
authors.initials: SJ
authors.lastname: Chang
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Lee
mesh_terms: 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
chemical_list: D000959:Antihypertensive Agents; D011433:Propranolol