Utility of Doppler ultrasound derived hepatic and portal venous waveforms in the management of heart failure exacerbation

Singh, Swaiman; Koratala, Abhilash

doi:10.1002/ccr3.2908

Cited by 17 publications

(11 citation statements)

References 16 publications

(21 reference statements)

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“…In our experience, increased portal vein pulsatility fraction associated with volume overload often improves with diuretic treatment. 61,62 Even though a plethoric, non-collapsible IVC indicates venous congestion, caution must be exercised when interpreting it in patients with cardiac conditions impeding venous return (Chronic RV dysfunction/tricuspid regurgitation, RV myocardial infarction, Cardiac tamponade); These patients may be fluid responsive despite IVC plethora 63 . The evaluation of hemodynamic AKI in these conditions can be enhanced by assessing portal vein flow; increased portal pulsatility is suggestive of congestive AKI, which can potentially improve with decongestive therapy.…”

Section: Portal Vein Dopplermentioning

confidence: 99%

Comprehensive Assessment of Fluid Status by Point-of-Care Ultrasonography

2021

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The management of complex fluid and electrolyte disorders is central to the practice of nephrologists. The sensitivity of physical examination alone to determine fluid status is limited, precluding accurate clinical decision making. Point-of-Care Ultrasonography (POCUS) is emerging as a valuable non-invasive bedside diagnostic tool for objective evaluation of physiological and hemodynamic parameters related to fluid status, tolerance, and responsiveness. Rapid bedside sonographic evaluation can obtain qualitative data on cardiac function as well as quantitative data on pulmonary congestion. Advanced POCUS, including goal-directed Doppler echocardiography provides additional quantitative information including flow velocities and pressures across the cardiac structures. Recently, abnormal Doppler flow patterns in abdominal organs secondary to increased right atrial pressure have been linked to congestive organ damage adding another component to the hemodynamic assessment. Integrating POCUS findings with clinical and laboratory data can further elucidate a patient's hemodynamic status. This drives decisions regarding crystalloid administration or, conversely, diuresis or ultrafiltration and allows tailored therapy for individual patients. In this article, we provide an overview of the focused assessment of cardiovascular function, pulmonary and venous congestion using POCUS and review relevant literature.

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Section: Portal Vein Dopplermentioning

confidence: 99%

Comprehensive Assessment of Fluid Status by Point-of-Care Ultrasonography

2021

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“…Since its introduction, there have been multiple clinical applications of VExUS parameters. It has been used in guiding targeted fluid removal in cardiorenal syndrome, diagnosing subtypes of hyponatremia, determining the cause of AKI, predicting postoperative AKI, evaluating right ventricular dysfunction, and guiding decongestive therapy in heart failure [ 4 , 7 - 8 ]. Our case describes another potential application of VExUS where it can be used by the anesthesiologist in the perioperative period to guide therapeutic interventions in patients with advanced heart disease.…”

Section: Discussionmentioning

confidence: 99%

“…Although first introduced as a prognostic tool for AKI, subsequent uses of VExUS have demonstrated its potential to be used to guide therapeutic decision-making [ 4 , 7 , 8 ]. The perioperative management of heart failure patients, as highlighted by our case is another area where VExUS can prove to be useful.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Venous Excess Ultrasound Score (VExUS) to Guide Decongestion in a Dilated Cardiomyopathy Patient Presenting for Urgent Surgery

Singh¹,

Carvalho²

2021

Cureus

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Venous excess ultrasound score (VExUS) is a recently described ultrasound-based scoring system that quantifies systemic congestion using Doppler flow indices of the hepatic and portal vein in addition to inferior vena cava assessment. There are many potential and emerging applications of this modality. We discuss the case of a severely congested heart failure patient presenting for urgent non-cardiac surgery where VExUS parameters were used to monitor and guide his decongestive therapy postoperatively.

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“…4c). With effective decongestive therapy, these changes revert back to baseline mirroring the changes in RAP [45].…”

Section: The Pipesmentioning

confidence: 99%

Point of Care Ultrasonography for Objective Assessment of Heart Failure: Integration of Cardiac, Vascular, and Extravascular Determinants of Volume Status

Koratala

Kazory

2021

Cardiorenal Med

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Background: Lingering congestion portends poor outcomes in patients with heart failure (HF) and is a key target in their management. Studies have shown that physical exam has low yield in this setting and conventional methods for more precise assessment and monitoring of volume status (e.g., body weight, natriuretic peptides, and chest radiography) have significant inherent shortcomings. Summary: Point of care ultrasonography (POCUS) is a noninvasive versatile bedside diagnostic tool that enhances the sensitivity of conventional physical examination to gauge congestion in these patients. It also aids in monitoring the efficacy of decongestive therapy and bears prognostic significance. In this narrative review, we discuss the role of focused sonographic assessment of the heart, venous system, and extravascular lung water/ascites (i.e., the pump, pipes, and the leaks) in objective assessment of fluid volume status. Key Messages: Since each of the discussed components of POCUS has its limitations, a combinational ultrasound evaluation guided by the main clinical features would be the key to reliable assessment and effective management of congestion in patients with HF.

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Utility of Doppler ultrasound derived hepatic and portal venous waveforms in the management of heart failure exacerbation

Cited by 17 publications

References 16 publications

Comprehensive Assessment of Fluid Status by Point-of-Care Ultrasonography

Comprehensive Assessment of Fluid Status by Point-of-Care Ultrasonography

Perioperative Venous Excess Ultrasound Score (VExUS) to Guide Decongestion in a Dilated Cardiomyopathy Patient Presenting for Urgent Surgery

Point of Care Ultrasonography for Objective Assessment of Heart Failure: Integration of Cardiac, Vascular, and Extravascular Determinants of Volume Status

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