Association between right heart diastolic function and clinical presentation of chronic venous disease and primary varicose veins of lower extremities.

Abstract

This study examines the association between right heart diastolic function and clinical presentation of chronic venous disease and primary varicose veins of lower extremities. We performed retrospective analysis of clinical, peripheral venous Duplex and tricuspid Doppler (early diastolic inflow E-wave, late diastolic inflow A-wave, ratios of E to A waves, early diastolic annular e'-wave, late diastolic annular a'-wave and systolic annular s'- wave) data of 85 patients, 133 legs with primary varicose veins. We found following significant (p-value < 0.05) associations between tricuspid Doppler and clinical presentation of chronic venous disease and primary varicose veins: Clinical Etiological Anatomical Pathophysiological clinical class influenced late diastolic inflow velocities (C6 class A-wave +11.2 cm/s or +27% in comparison with C2), late diastolic annular velocities (C6 class a'-wave +3.3 cm/s or +22% in comparison with C2), systolic annular velocities (C6 class s'-wave +3.7 cm/s or +27% in comparison with C2) and E/A ratios (C6 class E/A ratio -0.22 or -21% in comparison with C2). Recurrent varices in comparison with previously untreated are associated with significantly lower late diastolic inflow velocities (A-wave -4.4 cm/s or -9%) and preserved E/A ratios. Age significantly influenced tricuspid Doppler (E-, A-, e'-, a'-waves and E/A ratios) in patients with chronic venous disease. Clinical presentation of primary varicose veins and chronic venous disease can be associated with the right heart diastolic function: C6 Clinical Etiological Anatomical Pathophysiological class in comparison with C2 is associated with increased right ventricular filling and impaired ventricular relaxation - right heart diastolic dysfunction; recurrent varices in comparison with previously untreated are associated with reduced right ventricular filling and preserved right heart diastolic function. Older age is the most important risk factor for varicose veins and chronic venous disease possible due to significant changes in right ventricular filling and in right heart diastolic function with age.