Key result
Heart rate and rhythm abnormalities distort hepatic vein spectral Doppler and mimic right heart pathology.
Awareness of how arrhythmias and conduction disorders alter hepatic vein Doppler flow patterns is crucial to avoid misinterpreting these signals as right heart pathology.
Alerts clinicians to arrhythmia-induced hepatic vein Doppler artifacts; leaves open prospective validation of diagnostic thresholds.
Doppler interrogation of blood flow in the hepatic veins (HVs) provides valuable information regarding a wide spectrum of pathological processes that affect the right heart. Systematic analysis of the direction, velocity, and phasicity of the HV waveforms allows one to distinguish normal from abnormal patterns and provides important diagnostic information. Abnormalities in heart rate, rhythm, and intracardiac conduction are commonly encountered during echocardiographic studies. Sinus bradycardia and tachycardia, bradyarrhythmias and tachyarrhythmias as well as atrioventricular conduction disturbances influence the flow pattern in the HVs and may pose a challenge to the correct interpretation of the HV Doppler. Alterations in HV flow that are induced by the electrical abnormalities may mimic right heart pathology. Awareness of these alterations allows one to avoid misinterpretation of the HV signal, helps diagnose the underlying rhythm or conduction abnormality, and permits assessment of the impact on right heart hemodynamics.
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Fadel et al. (2015) conducted a review in Rate, rhythm, and conduction disorders. Spectral Doppler of the Hepatic Veins was evaluated. Spectral Doppler interrogation of the hepatic veins is influenced by heart rate, rhythm, and conduction abnormalities, which can mimic right heart pathology and require careful interpretation.
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