Hepatic arterial resistance in cirrhosis with and without portal vein thrombosis: Relationships with portal hemodynamics

Sacerdoti, David; Merkel, Carlo; Bolognesi, Massimo; Amodio, Piero; Angeli, Paolo; Gatta, Angelo

doi:10.1016/0016-5085(95)90214-7

Cited by 140 publications

(114 citation statements)

References 31 publications

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“…In fact, we have previously demonstrated that differences in hepatic artery Doppler impedance indexes between normal and diseased livers become less evident the nearer to the aorta. 2 Consequently, a difference in hepatic artery RI between normal and diseased livers was only found when measured inside the liver, either when increased [2][3][4] or decreased, as also recently shown in this journal. 4 Furthermore, in the work by Taourel et al, the hepatic artery RI was not corrected according to the heart rate, as proposed by Mostbeck et al for parenchymal arteries, 5 so that it is not possible to exclude that differences in heart rates among patients could have hindered a final positive result…”

supporting

confidence: 79%

Splanchnic arterial doppler parameters in portal hypertension

et al. 1999

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We read with great interest the article by Taourel et al. 1 on the relationships among Doppler measurements of splanchnic vessels, hepatic venous pressure gradient (HVPG), variceal size, and Child-Pugh class in patients affected by alcoholic cirrhosis. The authors found a significant inverse correlation of portal velocity and portal vein flow with HVPG. On the other hand, no correlation was evident between Doppler resistance index (RI) in the hepatic or superior mesenteric arteries and HVPG.In our opinion, the two latter findings present some methodological limitations, which make the possible correlation between these arterial Doppler parameters and HPVG unlikely to be definitively excluded. The hepatic artery RI was measured at the porta hepatis and not inside the liver. The former sampling site, however, adds more information than the latter. In fact, we have previously demonstrated that differences in hepatic artery Doppler impedance indexes between normal and diseased livers become less evident the nearer to the aorta. 2 Consequently, a difference in hepatic artery RI between normal and diseased livers was only found when measured inside the liver, either when increased 2-4 or decreased, as also recently shown in this journal. 4 Furthermore, in the work by Taourel et al., the hepatic artery RI was not corrected according to the heart rate, as proposed by Mostbeck et al. for parenchymal arteries, 5 so that it is not possible to exclude that differences in heart rates among patients could have hindered a final positive resultThe superior mesenteric artery RI was used by Taourel et al. to correlate the degree of splanchnic vasodilatation, a landmark of cirrhotic hyperkinetic circulation, with portal pressure, but no statistically significant relationship was found. 1 Some recent data show that the pulsatility index is more sensitive than the RI in detecting early impedance changes in the superior mesenteric artery. 6 This seems to be caused by the disappearance of the postsystolic reversal of flow in cirrhosis, differently from the usual pattern of normal fasting subjects. 6 Thus, early circulatory alterations, affecting only this short reversal of flow, can only influence the superior mesenteric artery pulsatility index, but have no effect on the RI. In addition, the measurement of the pulsatility index, being insensitive to heart rate, avoids the related biases. This is particularly important in this district, because an adequate correction for heart rate is prevented by the peculiar flow trace.We believe, therefore, that the use of the pulsatility index, rather than the RI, could offer more precise information about the superior mesenteric arterial district and that this index should be used to search for correlation with HVGP.In conclusion, we believe that further methodological refinements might improve the interesting splanchnic hemodynamic findings of Taourel et al.

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confidence: 79%

Splanchnic arterial doppler parameters in portal hypertension

et al. 1999

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“…Inter-and intraobserver reproducibility data have been reported elsewhere [15,16]. Color Doppler sonography was used to assess splanchnic hemodynamic parameters.…”

Section: Doppler Sonographymentioning

confidence: 99%

“…-The hepatic arterial pulsatility index (PI-L) was measured in the left branch of the hepatic artery and was calculated according to the formula: (peak systolic velocity e end diastolic velocity/mean velocity) [15]. -The splenic arterial pulsatility index (PI-S) was measured in the main branches of the splenic artery and calculated according to the formula: (peak systolic velocity e end diastolic velocity/mean velocity) [15,19].…”

Section: Doppler Sonographymentioning

confidence: 99%

Nonalcoholic fatty liver disease (NAFLD) in nonobese patients with diabetes: Prevalence and relationships with hemodynamic alterations detected with Doppler sonography

Gaiani

Avogaro

Bombonato

et al. 2009

Journal of Ultrasound

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Aim: To evaluate the prevalence, severity, and hemodynamic features of nonalcoholic fatty liver disease (NAFLD) in nonobese diabetics. Methods: We studied 100 consecutive nonobese (body mass index [BMI] < 30) patients with type 1 (n Z 17) or type 2 (n Z 83) diabetes and no known causes of liver disease. Steatosis was diagnosed and graded with ultrasonography. Digital sonographic images of the liver and right kidney were analyzed with dedicated software (HDI-Lab), and the liver/kidney ratio of grey-scale intensity was calculated as an index of the severity of the steatosis. Severity scores ranging from 0 (none) to 5 (severe) were compared with sonographic and Doppler findings (right liver size, portal vein diameter and flow velocity, hepatic and splenic arterial pulsatility indices, hepatic-vein flow profile and A-and S-wave velocities). Results: The prevalence of steatosis was 24% in type I and 80% in type II diabetes (grade 1 in 17%, grade 2 in 34%, grade 3 in 33%, grade 4 in 9%, grade 5 in 7%). In patients with steatosis (especially those with grades 4e5 disease), hepatic volume was increased (p < 0.005). Portal vein diameter was increased in grade 5 steatosis. The hepatic artery pulsatility index was significantly increased, particularly in grades 4 and 5 (p < 0.0001); portal and A-wave velocities were significantly reduced in grades 3e5 (p < 0.001); and the hepatic vein flow profile was altered in 27% (biphasic: 20%, flat: 7%) patients with steatosis, although there was no correlation with severity. Conclusions: NAFLD is very frequent in nonobese diabetics with type 2 but not type 1 disease, and it is associated with hepatomegaly and liver hemodynamic alterations only when it is severe.

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“…O padrão das curvas espectrais das veias supra-hepáticas em cirróticos também foi investigado por Bolondi et al (1991 O comportamento da artéria hepática na hipertensão portal também foi objeto de estudo de vários autores, todos com resultados bastante semelhantes (Sacerdoti et al, 1995;Piscaglia et al, 1997;Colli et al, 1998e Schneider et al, 1999: o aumento do índice de resistividade da artéria concomitante ao aumento da pressão portal. Erden et al (1999), avaliando o índice de resistividade da artéria hepática de pacientes com hipertensão portal em sítios diferentes (pré-sinusoidal e sinusoidal) e de indivíduos sadios, destacaram que a resistência arterial hepática não se altera nos pacientes com quadro hipertensivo pré-sinusoidal, enquanto nos pacientes com hipertensão sinusoidal essa resistência encontra-se significativamente aumentada.…”

Section: Ultrassonografia Doppler Na Avaliação Da Hemodinâmica Portalunclassified

“…Os estudos do comportamento da artéria hepática na hipertensão portal cirrótica indicam que paralelamente ao aumento da pressão portal ocorre aumento do índice de resistividade da artéria (Sacerdoti et al, 1995;Piscaglia et al, 1997;Colli et al, 1998;Schneider et al, 1999). No entanto, Erden et al (1999) Bogliolo (1956b), Coutinho et al (1964) e Speranzini (1971, apud Cerri, 1984a, estava dentro dos limites normais em todos os parâmetros avaliados e acompanhou passivamente a hemodinâmica do processo patogênico esquistossomótico.…”

Section: Associações Estastisticasunclassified

Avaliação ultrassonográfica e dopplervelocimétrica da esquistossomose mansônica: estudo de campo em áreas de baixa, média e alta endemicidades

Azeredo¹

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Hepatic arterial resistance in cirrhosis with and without portal vein thrombosis: Relationships with portal hemodynamics

Cited by 140 publications

References 31 publications

Splanchnic arterial doppler parameters in portal hypertension

Splanchnic arterial doppler parameters in portal hypertension

Nonalcoholic fatty liver disease (NAFLD) in nonobese patients with diabetes: Prevalence and relationships with hemodynamic alterations detected with Doppler sonography

Avaliação ultrassonográfica e dopplervelocimétrica da esquistossomose mansônica: estudo de campo em áreas de baixa, média e alta endemicidades

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