The Diagnostic Value of Spectral Doppler echocardiography of the middle
Hepatic Vein in Pulmonary Hypertension
Abstract
Background: Doppler echocardiographic parameters of the middle
hepatic vein (MHV)in detecting PHTN. Methods: The study
comprised 72 patients who were referred for right heart catheterization
(RHC) to our department . All patients underwent conventional
transthoracic echocardiography (TTE) the day after RHC and Doppler study
of the MHV. Based on RHC and TTE results, Patients were divided in three
groups 1: patients with PHTN without significant RV dysfunction (n=25),
2: patients with PHTN with significant RV dysfunction (n=22), 3:
patients with normal PAP (n=25). Results: The analysis revealed
a significant relationship between A velocity and PHTN among patients
with significant RV dysfunction (p=0.033) and PHTN without significant
RV dysfunction (p=0.020). At cut-off value of 39.5 cm/s, A velocity
could detect PHTN in patient with significant RV dysfunction with
sensitivity and specificity of 77.3% and 56.0%, respectively. At
cut-off value of 38.5 cm/s, A velocity could detect PHTN without
significant RV dysfunction with sensitivity and specificity of 76.0%
and 51.0%, respectively. The ROC curve analysis was performed to assess
the sensitivity of the hepatic venous systolic filling fraction in
detecting normal SPAP in the study population. The area under curve was
0.718. Considering the cut-off value of 0.535 for the hepatic venous
systolic filling fraction, the sensitivity and specificity of S/S+D for
detecting normal SPAP were 80% and 64%, respectively .
Discussion: Doppler echocardiographic parameters of the MHV
could be helpful in detecting PHTN. A/S higher than 1 in PHTN was the
main finding on HV Doppler assessment in PHT with and without
significant RV dysfunction. HV systolic filling fraction more than 0.535
was a sensitive parameter in detecting normal PAP, therefore; HV
systolic filling fraction can be used as a screening echocardiographic
parameter in ruling out PHTN.