Recent variceal bleeding

Doppler US hepatic vein waveform in assessment of severity of portal hypertension and vasoactive drug response

Soon Koo Baik, Jae Woo Kim, Hyun Soo Kim, Sang Ok Kwon, Young Ju Kim, Joong Wha Park, Seong Hyun Kim, Sei Jin Chang, Dong Ki Lee, Kwang Hyub Han, Soon-Ho Um, Samuel S. Lee

Research output: Contribution to journalArticle

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Abstract

Purpose: To prospectively evaluate both the correlation between abnormal Doppler ultrasonography (US) hepatic vein waveforms and the hepatic venous pressure gradient (HVPG) and the response to drug treatment in patients with cirrhosis. Materials and Methods: Ethics committee approval and informed consent of patients and control subjects were obtained. In 78 patients with cirrhosis (70 men, eight women; mean age, 49.4 years ± 9.7 [standard deviation]) and a history of variceal bleeding, both the hepatic vein waveform-as measured with Doppler US-and the HVPG were measured, and the relationship between them was analyzed. Hepatic vein Doppler waveforms were classified as triphasic, biphasic, or monophasic. Severe portal hypertension was defined as an HVPG of more than 15 mm Hg. In a subgroup of 21 patients, changes in hepatic vein waveform and HVPG were evaluated after intravenous administration of 2 mg of terlipressin. Statistical analyses were performed with Spearman rank correlation, logistic regression analysis, and cross tabulation. Results: Abnormal hepatic vein waveforms were seen in 72 patients (92%). Forty-four patients (56%) had biphasic waveforms, 28 (36%) had monophasic waveforms, and six (8%) had triphasic waveforms. A positive correlation was found between the extent of abnormalities in hepatic vein waveforms and the increase in HVPG (P < .05). Monophasic waveforms were associated with severe portal hypertension, with a sensitivity of 74% and a specificity of 95%. Twenty patients in the terlipressin subgroup had abnormal baseline waveforms; the baseline waveform improved in 18 patients in association with the HVPG reduction after injection of terlipressin. Conclusion: Doppler US hepatic vein waveform assessment is useful in the noninvasive evaluation of the severity of portal hypertension and the response to vasoactive drugs in patients with portal hypertension and variceal bleeding.

Original languageEnglish
Pages (from-to)574-580
Number of pages7
JournalRadiology
Volume240
Issue number2
DOIs
Publication statusPublished - 2006 Aug 1

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Doppler Ultrasonography
Hepatic Veins
Portal Hypertension
Venous Pressure
Hemorrhage
Pharmaceutical Preparations
Liver
Fibrosis
Ethics Committees
Informed Consent
Intravenous Administration
Logistic Models
Regression Analysis
Injections

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Recent variceal bleeding : Doppler US hepatic vein waveform in assessment of severity of portal hypertension and vasoactive drug response. / Baik, Soon Koo; Kim, Jae Woo; Kim, Hyun Soo; Kwon, Sang Ok; Kim, Young Ju; Park, Joong Wha; Kim, Seong Hyun; Chang, Sei Jin; Lee, Dong Ki; Han, Kwang Hyub; Um, Soon-Ho; Lee, Samuel S.

In: Radiology, Vol. 240, No. 2, 01.08.2006, p. 574-580.

Research output: Contribution to journalArticle

Baik, SK, Kim, JW, Kim, HS, Kwon, SO, Kim, YJ, Park, JW, Kim, SH, Chang, SJ, Lee, DK, Han, KH, Um, S-H & Lee, SS 2006, 'Recent variceal bleeding: Doppler US hepatic vein waveform in assessment of severity of portal hypertension and vasoactive drug response', Radiology, vol. 240, no. 2, pp. 574-580. https://doi.org/10.1148/radiol.2402051142
Baik, Soon Koo ; Kim, Jae Woo ; Kim, Hyun Soo ; Kwon, Sang Ok ; Kim, Young Ju ; Park, Joong Wha ; Kim, Seong Hyun ; Chang, Sei Jin ; Lee, Dong Ki ; Han, Kwang Hyub ; Um, Soon-Ho ; Lee, Samuel S. / Recent variceal bleeding : Doppler US hepatic vein waveform in assessment of severity of portal hypertension and vasoactive drug response. In: Radiology. 2006 ; Vol. 240, No. 2. pp. 574-580.
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abstract = "Purpose: To prospectively evaluate both the correlation between abnormal Doppler ultrasonography (US) hepatic vein waveforms and the hepatic venous pressure gradient (HVPG) and the response to drug treatment in patients with cirrhosis. Materials and Methods: Ethics committee approval and informed consent of patients and control subjects were obtained. In 78 patients with cirrhosis (70 men, eight women; mean age, 49.4 years ± 9.7 [standard deviation]) and a history of variceal bleeding, both the hepatic vein waveform-as measured with Doppler US-and the HVPG were measured, and the relationship between them was analyzed. Hepatic vein Doppler waveforms were classified as triphasic, biphasic, or monophasic. Severe portal hypertension was defined as an HVPG of more than 15 mm Hg. In a subgroup of 21 patients, changes in hepatic vein waveform and HVPG were evaluated after intravenous administration of 2 mg of terlipressin. Statistical analyses were performed with Spearman rank correlation, logistic regression analysis, and cross tabulation. Results: Abnormal hepatic vein waveforms were seen in 72 patients (92{\%}). Forty-four patients (56{\%}) had biphasic waveforms, 28 (36{\%}) had monophasic waveforms, and six (8{\%}) had triphasic waveforms. A positive correlation was found between the extent of abnormalities in hepatic vein waveforms and the increase in HVPG (P < .05). Monophasic waveforms were associated with severe portal hypertension, with a sensitivity of 74{\%} and a specificity of 95{\%}. Twenty patients in the terlipressin subgroup had abnormal baseline waveforms; the baseline waveform improved in 18 patients in association with the HVPG reduction after injection of terlipressin. Conclusion: Doppler US hepatic vein waveform assessment is useful in the noninvasive evaluation of the severity of portal hypertension and the response to vasoactive drugs in patients with portal hypertension and variceal bleeding.",
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T2 - Doppler US hepatic vein waveform in assessment of severity of portal hypertension and vasoactive drug response

AU - Baik, Soon Koo

AU - Kim, Jae Woo

AU - Kim, Hyun Soo

AU - Kwon, Sang Ok

AU - Kim, Young Ju

AU - Park, Joong Wha

AU - Kim, Seong Hyun

AU - Chang, Sei Jin

AU - Lee, Dong Ki

AU - Han, Kwang Hyub

AU - Um, Soon-Ho

AU - Lee, Samuel S.

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N2 - Purpose: To prospectively evaluate both the correlation between abnormal Doppler ultrasonography (US) hepatic vein waveforms and the hepatic venous pressure gradient (HVPG) and the response to drug treatment in patients with cirrhosis. Materials and Methods: Ethics committee approval and informed consent of patients and control subjects were obtained. In 78 patients with cirrhosis (70 men, eight women; mean age, 49.4 years ± 9.7 [standard deviation]) and a history of variceal bleeding, both the hepatic vein waveform-as measured with Doppler US-and the HVPG were measured, and the relationship between them was analyzed. Hepatic vein Doppler waveforms were classified as triphasic, biphasic, or monophasic. Severe portal hypertension was defined as an HVPG of more than 15 mm Hg. In a subgroup of 21 patients, changes in hepatic vein waveform and HVPG were evaluated after intravenous administration of 2 mg of terlipressin. Statistical analyses were performed with Spearman rank correlation, logistic regression analysis, and cross tabulation. Results: Abnormal hepatic vein waveforms were seen in 72 patients (92%). Forty-four patients (56%) had biphasic waveforms, 28 (36%) had monophasic waveforms, and six (8%) had triphasic waveforms. A positive correlation was found between the extent of abnormalities in hepatic vein waveforms and the increase in HVPG (P < .05). Monophasic waveforms were associated with severe portal hypertension, with a sensitivity of 74% and a specificity of 95%. Twenty patients in the terlipressin subgroup had abnormal baseline waveforms; the baseline waveform improved in 18 patients in association with the HVPG reduction after injection of terlipressin. Conclusion: Doppler US hepatic vein waveform assessment is useful in the noninvasive evaluation of the severity of portal hypertension and the response to vasoactive drugs in patients with portal hypertension and variceal bleeding.

AB - Purpose: To prospectively evaluate both the correlation between abnormal Doppler ultrasonography (US) hepatic vein waveforms and the hepatic venous pressure gradient (HVPG) and the response to drug treatment in patients with cirrhosis. Materials and Methods: Ethics committee approval and informed consent of patients and control subjects were obtained. In 78 patients with cirrhosis (70 men, eight women; mean age, 49.4 years ± 9.7 [standard deviation]) and a history of variceal bleeding, both the hepatic vein waveform-as measured with Doppler US-and the HVPG were measured, and the relationship between them was analyzed. Hepatic vein Doppler waveforms were classified as triphasic, biphasic, or monophasic. Severe portal hypertension was defined as an HVPG of more than 15 mm Hg. In a subgroup of 21 patients, changes in hepatic vein waveform and HVPG were evaluated after intravenous administration of 2 mg of terlipressin. Statistical analyses were performed with Spearman rank correlation, logistic regression analysis, and cross tabulation. Results: Abnormal hepatic vein waveforms were seen in 72 patients (92%). Forty-four patients (56%) had biphasic waveforms, 28 (36%) had monophasic waveforms, and six (8%) had triphasic waveforms. A positive correlation was found between the extent of abnormalities in hepatic vein waveforms and the increase in HVPG (P < .05). Monophasic waveforms were associated with severe portal hypertension, with a sensitivity of 74% and a specificity of 95%. Twenty patients in the terlipressin subgroup had abnormal baseline waveforms; the baseline waveform improved in 18 patients in association with the HVPG reduction after injection of terlipressin. Conclusion: Doppler US hepatic vein waveform assessment is useful in the noninvasive evaluation of the severity of portal hypertension and the response to vasoactive drugs in patients with portal hypertension and variceal bleeding.

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