Relationship between hepatic haemodynamics assessed by Doppler ultrasound and liver stiffness.

AIM: We tested the relationship between hepatic haemodynamics assessed by Doppler ultrasonography and liver stiffness assessed by Transient Elastography in hepatitis C related chronic liver disease. METHODS: Three liver Doppler ultrasound parameters (hepatic artery resistance index, splenic artery resistance index and waveform pattern in hepatic veins) and liver stiffness measured by Transient Elastography were analysed in one hundred consecutive patients affected by hepatitis C related chronic liver disease. RESULTS: Hepatic and splenic arteries resistance indexes correlate significantly (p<0.0001 for both) with liver stiffness. A hepatic artery resistance index cut-off value of 0.64 provided sensitivity and specificity respectively of 84.4% and 69.1% for predicting liver stiffness ≤or >13 kPa, whereas a splenic artery resistance index cut-off value of 0.56 provided sensitivity and specificity respectively of 81.3% and 48.5%. The coincidental finding of both resistance indexes above the respective cut-off values showed a good accuracy in identifying patients with liver stiffness values >13 kPa (accuracy=78%, +LR=2.90, -LR=0.31). A significant difference in liver stiffness values was evident between patients with triphasic and bi- or monophasic waveform pattern (p=0.005). CONCLUSIONS: Hepatic and splenic arteries resistance indexes and the hepatic veins waveform pattern assessed by Doppler ultrasound may provide information similar to that of Transient Elastography in hepatitis C related chronic liver disease.

Systemic and regional hemodynamics in pre-ascitic cirrhosis: effects of posture.

BACKGROUND/AIMS: To clarify the hemodynamic pattern of pre-ascitic cirrhosis, we compared the impact of posture on systemic and regional hemodynamics of patients and healthy subjects without and with plasma volume expansion. METHODS: Cardiac index (CI), peripheral vascular resistance (PVRi), heart rate, mean arterial pressure, and the mean blood flow velocities of superior mesenteric (SMAV) and common femoral arteries were evaluated by duplex-Doppler techniques in 10 patients and 20 healthy controls after 2 h of standing and 2 h after lying down. Ten healthy controls received saline infusion (15 ml/kg body weight) when they changed their posture, and five were also evaluated after plasma volume expansion in the upright posture. RESULTS: Standing systemic and regional hemodynamics did not differ between patients and controls. After saline infusion, standing control subjects showed greater CI and SMAV than patients. Recumbency caused changes of CI, PVRi and SMAV greater in patients and controls with plasma expansion than in controls without expansion, so that supine patients and controls with expansion were indistinguishable, showing higher CI and SMAV and lower PVRi than controls without expansion. CONCLUSIONS: Systemic and regional hemodynamics of patients with pre-ascitic cirrhosis are mainly determined by blood volume expansion which is compartmentalized within the splanchnic venous bed during standing and translocates towards the central and arterial circulatory districts during recumbency.