ГЕПАТОПОРТАЛЬНАЯ ГЕМОДИНАМИКА У БОЛЬНЫХ С ОСТРОЙ ДЕКОМПЕНСАЦИЕЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ

Abstract

The aim of the study. To study the features of hepatoportal hemodynamics in patients with acute decompensated heart failure.Material and methods. The study included 138 patients with chronic heart failure admitted to the RRCEM due to the development of acute decompensation of heart failure. The average age of the patients was 66.02 ± 10.41 years. As a control group, the study included 20 healthy volunteers of the corresponding age. During hospitalization, all patients were assessed for the structural and functional state of the left and right heart, as well as the characteristics of the hepatic and pulmonary blood flow.Results. In patients with acute decompensation of heart failure, the hepatic artery was characterized by an increase in its diameter (p <0.001), the resistance index significantly exceeded the indicator recorded in healthy volunteers (p <0.001), which reflects the presence of portal hypertension. The study of hemodynamics in the portal vein revealed an increase in the diameter of the vein (p <0.05) and an acceleration of the volumetric blood flow velocity (p <0.001). At the same time, the pulsation index was increased (p <0.001), which is typical for a change in the flow profile against the background of right ventricular chronic heart failure. Signs of portal hypertension were recorded in the study of blood flow in the splenic artery: its diameter, linear and volumetric blood flow velocity were increased (p <0.001 for artery diameter and volumetric blood flow velocity and p <0.01 for linear blood flow velocity).Conclusion. In patients with acute decompensated heart failure, in addition to impaired systolic function of the left ventricle, there is a significant violation of hepatoportal hemodynamics with the development of portal hypertension, a decrease in arterial hepatic blood flow and obstruction of hepatic venous outflow with signs of fibrotic changes in the hepatic parenchyma. The degree of change increases with a decrease in the left ventricular ejection fraction.