Hepatic vein waveform in liver cirrhosis: correlation with child's class and size of varices.

OBJECTIVE: To determine the correlation of hepatic venous waveform changes with severity of hepatic dysfunction and grading of oesophageal varices.

METHODS: A cross-sectional analytical study was conducted at Jinnah Postgraduate Medical Centre, Karachi, Medical Unit-III, Ward-7 from January 2009 to December 2009. Cirrhotic patients with portal hypertension were included in study. Patients presented with acute variceal bleeding, previous treatment with beta blockers or nitrates, sclerotherapy endoscopic band ligation, portal vein thrombosis, severe clotting defects, hepatic encephalopathy grade III or IV and noncirrhotic portal hypertension; were excluded from the study. Upper G I endoscopy was carried out in all patients after informed consent. Oesophageal varices were classified according to Baveno III while hepatic function was assessed and grouped by Child-Pugh classification. Colour Doppler ultrasound was carried out on all patients. Their waveforms were classified as monophasic, biphasic triphasic and the correlation of these hepatic vein waveforms with Child-Pugh class and size of oesophageal varices was evaluated. Statistical significance was defined as P?0.05.

RESULTS: Total of 65 patients who met the inclusion criteria and included in the study with mean age of 47.39 +/- 10.91 (range 23-70) years. Among these 51 (78.5%) were males while 14 (21.5%) were females. On the basis of hepatic function 32 (49.2%) patients presented in Child-Pugh Class A, 23 (35.4%) with Class B and 10 (15.4%) patients had Class C. Hepatic venous waveform was triphasic in 5 (7.7%), biphasic in 18 (27.7%), and monophasic in 42 (64.6%) cases. The relationship of these waveforms had significant relation with hepatic dysfunction (p < 0.012) while insignificant with grading of oesophageal varices (p 0.29). Upper GI endoscopy revealed large grade varices in 37 (56.9%) patients, 17 (26.2%) patients had small grade varices while no varices were found in 11 (16.9%) patients.

CONCLUSION: Hepatic venous waveform pressure changes have significant relation with severity of hepatic dysfunction but insignificant relation with grading of oesophageal varices. Further studies using a combination of various Doppler parameters are required to create indices with a better predictive value.