Comparison of Portal Vein Doppler Indices and Hepatic Vein Doppler Waveform in Patients with Nonalcoholic Fatty Liver Disease with Healthy Control

Solhjoo, Ehsan; Ghanaei, F Mansour; Moulaei-Langorudi, Roghaeyh; Joukar, Farahnaz

doi:10.5812/kowsar.1735143x.729

Cited by 16 publications

(15 citation statements)

References 17 publications

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“…Mechanically, the flow pattern of portal veins and hepatic veins differ drastically as hepatic veins drain through an increasingly lower-resistance path to the inferior vena cava, while the portal veins flow into the higher resistance hepatic sinuses. In addition, hepatic veins have a highly-pulsatile flow that corresponds to the cardiac cycle while portal veins are associated with a more damped, continuous flow (19–21). The higher peak flow rate of hepatic veins compared to portal veins in this study, while not statistically significant, may have contributed to a larger heat-sink effect and protected the veins from thrombosis (5).…”

Section: Discussion (800)mentioning

confidence: 99%

Potential Mechanisms of Vascular Thrombosis after Microwave Ablation in an in Vivo Liver

Chiang

Nickel

Kimple

et al. 2017

Journal of Vascular and Interventional Radiology

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Purpose The purpose of this study was to evaluate potential biological and thermal mechanisms for the observed differences in thrombosis rates between hepatic vessels during microwave ablation procedures. Materials and Methods Microwave ablation antennas were placed in single liver lobes of two in-vivo porcine (n=3 in each animal; n =6 total) liver models in the proximity of a large (>5mm) portal vein and hepatic veins. Each ablation was performed with 100 W for 5 minutes. Conventional ultrasound imaging and intravascular temperature probes were used to evaluate vessel patency and temperature changes during the ablation procedure. Vascular endothelium was harvested 1 hour after ablation and used to characterize genes and proteins associated with thrombosis in portal and hepatic veins. Results Targeted portal veins and hepatic veins did not show a significant difference between average vessel size (8.7 ± 2.4 mm vs 9.7 ± 3.4 mm; p=0.44). Portal veins within the microwave ablation zone thrombosed at a significantly higher rate compared to hepatic veins (54.5% vs 0.0%, p=0.0046). There was a negligible change in intravascular temperature in both portal and hepatic veins during the ablation procedure (0.2 ± 0.4 vs 0.6 ± 0.9 °C, p=0.46). Portal veins demonstrated significantly higher gene expression compared to hepatic veins in terms of fold-differences in thrombomodulin (2.9 ± 2.0; p=0.0001), von Willebrand Factor (7.6 ± 1.5; p=0.0001), endothelial protein C receptor (3.50 ± 0.49; p=0.0011) and plasminogen activator inhibitor (SERPINE1: 1.46 ± 0.05; p=0.0014). Western blot analysis showed significantly higher expression of von Willebrand Factor (2.32 ± 0.92; p=0.031) in portal veins compared to hepatic veins. Conclusions Large portal veins thrombose more frequently than hepatic veins during microwave ablation procedures. Biological differences in thrombogenicity, rather than heat transfer, between portal veins and hepatic veins may contribute to their different rates of thrombosis.

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Section: Discussion (800)mentioning

confidence: 99%

Potential Mechanisms of Vascular Thrombosis after Microwave Ablation in an in Vivo Liver

Chiang

Nickel

Kimple

et al. 2017

Journal of Vascular and Interventional Radiology

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“…This discrepancy might be caused by the observed increase of hepatic TG content after short-term high-fat diet leading to reduced compliance of the hepatic parenchyma. Hypertrophied hepatocytes might cause hepatic vein compression and subsequently decrease vein phasicity [38]. The hepatic veins drain blood from the hepatic sinusoids toward the inferior vena cava.…”

Section: Discussionmentioning

confidence: 99%

“…As a result of abnormal flow in the hepatic veins, blood flow in the inferior vena cava may also be anomalous. It has been recognized that the hepatic vein doppler waveform alters from triphasic to biphasic or monophasic in patients with non-alcoholic fatty liver disease (NAFLD) [38,39]. The early passive filling of the right atrium and ventricle may be disturbed, causing a decreased E/A.…”

Section: Discussionmentioning

confidence: 99%

Effects of Short-Term Nutritional Interventions on Right Ventricular Function in Healthy Men

et al. 2013

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BackgroundA physiological model of increased plasma nonesterified fatty acid (NEFA) levels result in myocardial triglyceride (TG) accumulation, which is related to cardiac dysfunction. A pathophysiological model of increased plasma NEFA levels result in hepatic steatosis, which has been linked to abnormal myocardial energy metabolism. Hepatic steatosis is accompanied by hepatic inflammation, reflected by plasma cholesteryl ester transfer protein (CETP) levels. The current study aimed to investigate effects of these models via different nutritional interventions on right ventricular (RV) function.MethodsFifteen men (age 25.0±6.6 years) were included and underwent magnetic resonance imaging and spectroscopy in this prospective crossover intervention study. RV function, myocardial and hepatic TG content, and CETP levels were assessed on three occasions: after normal diet, very low-calorie diet (VLCD, physiological model) and high-fat high-energy (HFHE, pathophysiological model) diet (all 3-days diets, randomly ordered, washout phase at least 14 days).ResultsVLCD induced a decrease in mean E deceleration by 27%. Myocardial TG content increased by 55%, whereas hepatic TG content decreased by 32%. Plasma CETP levels decreased by 14% (all P<0.05). HFHE diet induced a decrease in E/A by 19% (P<0.05). Myocardial TG content did not change, whereas hepatic TG content increased by 112% (P<0.01). Plasma CETP levels increased by 14% (P<0.05).ConclusionsThese findings show that RV diastolic function is impaired after short-term VLCD and HFHE diet in healthy men, respectively a physiological and a pathophysiological model of increased plasma NEFA levels. After short-term VLCD, myocardial lipotoxicity may be of importance in decreased RV diastolic function. RV diastolic dysfunction is accompanied by increased hepatic TG content and plasma CETP levels after short-term HFHE diet, suggesting that systemic inflammation reflecting local macrophage infiltration in the heart may be involved in RV dysfunction.

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“…26 The mean ± standard deviation (SD) of the portal vein diameter measured by sonographic evaluation in healthy subjects is widely variable. Published measurements include 11.45 ± 1.49, 22 10.35 ± 1.57, 27 6.3 ± 2.3, 28 and 11.0 ± 2.0. 29 In patients with known liver disease (cirrhosis and nonalcoholic steatohepatitis [NASH]), the reported portal vein diameters were 13.52 ± 2.48 18 and 10.77 ± 15.1, 27 respectively.…”

Section: Original Researchmentioning

confidence: 99%

“…Published measurements include 11.45 ± 1.49, 22 10.35 ± 1.57, 27 6.3 ± 2.3, 28 and 11.0 ± 2.0. 29 In patients with known liver disease (cirrhosis and nonalcoholic steatohepatitis [NASH]), the reported portal vein diameters were 13.52 ± 2.48 18 and 10.77 ± 15.1, 27 respectively. The threshold portal vein diameters beyond which a clinician may diagnose portal hypertension are reported to range from 10 mm 30 to 13 mm.…”

Section: Original Researchmentioning

confidence: 99%

The Prediction of Liver Disease Status Using a Combination of Sonographic and Doppler-Derived Observations of the Portal Venous System

Guthrie

2012

Journal of Diagnostic Medical Sonography

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A novel diagnostic test, named the PREW © score, was formulated to predict the known liver disease status of a purposive sample of 500 patients (304 cases and 196 controls) referred for abdominal sonograms. The score was defined by (P R E)/W, where P = portal vein pressure gradient (mm Hg), R = ratio between the observed mean portal vein diameter in the patient (mm) and the mean diameter in healthy subjects (mm), E = echogenicity of liver parenchyma (ECHO grade scale), and W = hepatic venous waveform (1 = monophasic to 3 = triphasic). Cases with PREW scores >50 were about 480 times more likely than the controls to be diagnosed with cirrhosis/ascites. Cases with PREW scores of 16 to 50 were about 6 to 15 times more likely than the controls to be diagnosed with hepatitis and about 15 to 120 times more likely to be diagnosed with cirrhosis/ascites. It was not possible to clearly discriminate between a diagnosis of hepatitis and cirrhosis/ascites if the PREW score was less than 50. The likelihoods of patients with PREW scores >25 being diagnosed with nonalcoholic fatty liver disease/steatohepatitis (NAFLD/NASH) or gallbladder (GB) disease were not statistically significant. A PREW score greater than 25 identified cases diagnosed with hepatitis/ cirrhosis/ascites but eliminated diagnoses of NAFLD/NASH/GB. The clinical implication is that a PREW score >50 may help to facilitate the diagnosis of cirrhosis without confirmation by liver biopsy.

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Comparison of Portal Vein Doppler Indices and Hepatic Vein Doppler Waveform in Patients with Nonalcoholic Fatty Liver Disease with Healthy Control

Cited by 16 publications

References 17 publications

Potential Mechanisms of Vascular Thrombosis after Microwave Ablation in an in Vivo Liver

Potential Mechanisms of Vascular Thrombosis after Microwave Ablation in an in Vivo Liver

Effects of Short-Term Nutritional Interventions on Right Ventricular Function in Healthy Men

The Prediction of Liver Disease Status Using a Combination of Sonographic and Doppler-Derived Observations of the Portal Venous System

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