Peripheral Venous Pulsatility Detected by Doppler Method for Diagnosis of Right Heart Failure

Krähenbühl, B; Restellini, A.; Frangos, A.

doi:10.1159/000173661

Cited by 23 publications

(15 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…When the central venous pressure (CVP) is high, the effect of the cardiac pulsations on peripheral veins is significant. 2 In our study, the right atrial pressure, a more objective sign of right-sided cardiac function than clinical findings, was compared to the flow velocities and PIs. Our results showed that an increase in right atrial pressure did not influence antero-grade flow velocities in the peripheral veins.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with rightsided cardiac dysfunction, the venous flow pattern in the patient's lower extemities tends to be pulsatile. [1][2][3] Abu-Yousef et al 1 found a significant correlation between increased right atrial pressure and pulsatile venous flow in the lower limbs. The visceral venous system also experiences flow variations caused by fluctuating right atrial pressure.…”

Section: Received 16 March 2000; Accepted 25 September 2000mentioning

confidence: 97%

See 1 more Smart Citation

Correlation of right atrial pressure and blood flow velocities in the common femoral vein obtained by duplex Doppler sonography

Alimoğlu

Erden

Gürsel

et al. 2001

J. Clin. Ultrasound

View full text Add to dashboard Cite

Purpose The purpose of this study was to correlate the right atrial pressure with the blood flow velocity and pulsatility index (PI) values obtained with duplex Doppler sonography of the common femoral vein. Methods Thirty consecutive patients with suspected right‐sided heart failure who had right atrial pressure measurements for correlation were included in the study. The common femoral veins were examined with duplex Doppler sonography. Irrespective of the presence or absence of clinical right‐sided heart failure, patients were divided into 2 groups on the basis of their right atrial pressures. The mean flow velocities and PIs in the common femoral veins of the 2 groups were compared. Results In patients with elevated right atrial pressure (≥G8 mm Hg), the mean minimum flow velocity ± standard deviation (−0.15 ± 0.11 m/second) in the common femoral vein was significantly lower than that in patients with normal right atrial pressure (< 8 mm Hg) (0.01 ± 0.10 m/second) (p < 0.001). There was no significant difference in the mean maximum flow velocities in the common femoral vein between the patients with elevated right atrial pressure (0.25 ± 0.08 m/second) and the patients with normal right atrial pressure (0.21 ± 0.09 m/second). The mean PI in patients with elevated right atrial pressure (7.75 ± 3.19) was significantly higher than the mean PI in patients with normal right atrial pressure (1.55 ± 1.30; p < 0.001). There was a weak negative correlation between the minimum flow velocity and the pressure in the right atrium in patients with elevated right atrial pressure (p = 0.05; r = −0.4760). The amplitude of retrograde waves seen in patients with normal right atrial pressure was significantly smaller than in patients with elevated right atrial pressure (p < 0.05). Conclusions The association of a decreased minimum velocity, especially a negative value, and an increase in PI in the common femoral vein may indicate an elevated right atrial pressure. Sonographic assessment of retrograde flow velocity in the common femoral vein may be useful in monitoring the response to medical treatment to decrease atrial pressure. © 2001 John Wiley & Sons, Inc. J Clin Ultrasound 29:87–91, 2001.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Received 16 March 2000; Accepted 25 September 2000mentioning

confidence: 97%

Correlation of right atrial pressure and blood flow velocities in the common femoral vein obtained by duplex Doppler sonography

Alimoğlu

Erden

Gürsel

et al. 2001

J. Clin. Ultrasound

View full text Add to dashboard Cite

show abstract

“…A, Normal LLVD sonographic venous tracing shows each waveform is made up of four waves that also span 1.2 s (one cardiac cycle on ECC tracing). Note that the initiation of the systolic wave (5), which begins at the crossing of the tracing with the baseline right after the 11 wave (a) on the Doppler tracing, is delayed by 0.4 s after the QRS complex (star on the ECC tracing). Titis is due to the collapsed state of the JVC Note that this interval was shorter in the TR patient in Figure 5, thought to be due to the speedy transmission that occurs when the IVC is dilated.…”

Section: Discussionmentioning

confidence: 99%

Pulsatile lower limb venous Doppler flow: prevalence and value in cardiac disease diagnosis.

Kakish

Abu‐Yousef

Brown

et al. 1996

Journal of Ultrasound in Medicine

View full text Add to dashboard Cite

The purpose of this study was to assess the frequency and significance of pulsatile Doppler waveforms in lower limb veins. We used Doppler sonographic data from the common femoral vein. In the first of two groups, the findings in 250 patients were correlated with the presence of cardiac decompensation on concurrent chest radiographs. In the second group, the findings in 81 patients were correlated with the presence of tricuspid regurgitation on Doppler echocardiograms. A venous Doppler sonographic examination was considered normal if spontaneous anterograde phasic flow was present and pulsatile if flow had a cyclic retrograde component. In group 1, 21% had pulsatile waveforms whereas 24% had cardiac decompensation. In group 2, 36% had pulsatile waveforms and 43% had tricuspid regurgitation. A statistically significant correlation was found between the presence of these abnormal waveforms and cardiac decompensation or tricuspid regurgitation, with sensitivities of 57% and 54%, specificities of 91% and 78%, positive predictive values of 66% and 66%, negative predictive values of 87% and 69%, and accuracies of 82% and 68%, respectively. In a subgroup of 55 patients who had both tests for correlation and in whom both were in agreement, the sensitivity of venous Doppler sonographic examination for detecting pathologic cardiac conditions was 79%, specificity was 87%, positive predictive value was 83%, negative predictive value was 84%, and accuracy was 84%. In 77 patients with pulsatile waveforms, including 24 without concurrent chest radiographs or echocardiograms, 63 (82%) had no prior history of cardiac disease. When correlated separately with chest radiograph or Doppler echocardiography, the test is not very sensitive in the diagnosis of cardiac disease; however, when both correlating tests are performed and are in agreement, all diagnostic parameters of the venous Doppler sonographic test, including sensitivity, become fairly high. The presence of pulsatile lower limb venous Doppler flow should alert the sonologist that a pathologic cardiac condition may be the culprit, especially in patients who have no such prior diagnosis.

show abstract

“…3,[16][17][18] Nonetheless, hardly any publications in the medical literature correlate the rise in right atrial pressure with the pulsatile wave spectrum in Doppler studies in the lower limbs. Krahenbuhl and coworkers were the first, in 1984, 4 and they obtained a sensitivity of 92%, a specificity of 89%, a PPV of 75%, and an NPV of 97% using Doppler interrogation. The optimum results of this series could be due to the unrefined measuring method, since it was based on recognizing a sound and did not have a baseline that allowed the researchers to detect retrograde flow objectively.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 We therefore investigated the relationship between high atrium pressure and pulsatile or retrograde flow in the CFV. We based our study on pulsed Doppler sonographic work on the liver that links portal vein pulsatility to congestive failure 6 and other studies that consider the suprahepatic vein pulsatility as a sign of tricuspid regurgitation.…”

mentioning

confidence: 99%

Correlation of central venous pressure with Doppler waveform of the common femoral veins.

Cozcolluela

Sarría

Sanz

et al. 2000

Journal of Ultrasound in Medicine

View full text Add to dashboard Cite

The objects of this prospective study were to determine the nature of the flow in the right femoral vein and to correlate the flow velocity with the venous pressure measured in the right atrium. We performed 236 pulsed Doppler ultrasonographic examinations in 1 year on patients with a venous catheter with the distal tip in the right atrium. In the Doppler wave readouts we analyzed wave frequency, velocity components, and relationships among them and the existence of pulsatile flow. These parameters were then compared to the right atrium pressure. We investigated the correlation between the atrium pressure and the flow velocity obtained from the Doppler waveforms of the common femoral veins, obtaining a significant correlation (P<0.0001) with the following: the atrium systolic wave a, the atrium diastolic wave v, the pulsatility ratio (PR = Vmin/Vmax) and the pulsatility index (PI = [Vmax ‐ Vmin] /Vavg). The receiver operating characteristic showed that the pulsed Doppler ultrasonography is not a sensitive technique in diagnosis high atrium pressures. In addition, both cardiac and respiratory phasicity of the venous wave was observed. A significant inverse relation was found between the pulsatile flow and high atrium pressure. Nonetheless, the low sensitivity of this technique does not allow the use of pulsatile Doppler ultrasonography in the common femoral vein for diagnosing increases of the atrium pressure.

show abstract

Peripheral Venous Pulsatility Detected by Doppler Method for Diagnosis of Right Heart Failure

Cited by 23 publications

References 3 publications

Correlation of right atrial pressure and blood flow velocities in the common femoral vein obtained by duplex Doppler sonography

Correlation of right atrial pressure and blood flow velocities in the common femoral vein obtained by duplex Doppler sonography

Pulsatile lower limb venous Doppler flow: prevalence and value in cardiac disease diagnosis.

Correlation of central venous pressure with Doppler waveform of the common femoral veins.

Contact Info

Product

Resources

About