Background Alterations in portal vein flow (PVF) are emerging as potential markers of venous congestion in congestive heart failure (HF); however, their dynamic changes during decongestion, and their utility in assessing HF status remain unclear. The aim of this study was to evaluate PVF parameter changes in HF patients during congestion and post-decongestive therapy, and their association with HF compensation and renal function. Patients and methods This cross-sectional study enrolled 35 HF patients (12 compensated, 23 noncompensated) at Assiut University Hospital’s ICU. Baseline and postdecongestion assessments included clinical evaluation, laboratory tests (e.g., eGFR, creatinine), point-of-care ultrasound (inferior vena cava size, PVF via Doppler), and echocardiography. PVF parameters (V.max, V.min, PI) were compared between groups and GFR categories, with diagnostic accuracy assessed through receiver-operating characteristic curves and predictors identified by logistic regression. Statistical significance was set at P less than 0.05. Results Mean age was 57 ± 12 years; 65.7% had noncompensated HF. At congestion, noncompensated HF showed lower V.max (15.13 ± 2.59 vs. 20.33 ± 3.34 cm/s), V.min (8.84 ± 1.64 vs. 9.47 ± 1.76 cm/s), and PI (0.41 ± 0.06 vs. 0.53 ± 0.06) than compensated HF ( P <0.001). PI decreased postdecongestion (0.5 ± 0.1 to 0.4 ± 0.1). V.max area under the curve (AUC)=0.630, specificity=100% and V.min (AUC=0.605, specificity=91.67%) had moderate diagnostic accuracy for noncompensated HF, unlike PI (AUC=0.527). PVF varied significantly with GFR ( P <0.001), with higher V.max and V.min in mild to dodtoatmoderate vs. severe GFR decline. Inferior vena cava size (OR=1.688, P =0.023) and right heart dilatation (OR=16.219, P =0.043) predicted noncompensated HF. Renal impairment was evident (eGFR 21.7 ± 8.4 ml/min/1.73 m²). Conclusion PVF parameters indicate venous congestion and renal function in HF, which change with decongestion, but are moderately diagnostically useful. POCUS-derived PVF assessment can potentially aid in the monitoring of HF, especially in the context of cardiorenal syndrome, but needs validation.
Khairallah et al. (Thu,) studied this question.