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Reshetnyak VI, Maev IV, Reshetnyak TM, Zhuravel SV, Pisarev VM. Liver Diseases and the Hemostasis (Rewiew) Part 1. Non-Cholestatic Diseases of the Liver and Hemostasis. GENERAL REANIMATOLOGY 2019. [DOI: 10.15360/1813-9779-2019-5-74-87] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In liver diseases, most commonly in the terminal stage of liver failure, a variety of hemostatic defects affecting almost all parts of the blood coagulation system are developing. This leads to diminishing the capabilities of patients with liver diseases to correctly maintain the hemostatic balance.The severity of hemostatic disorders depends on the nosological form and degree of a liver damage. Depending on the imbalance of the hemostasis system and accumulated clinical/laboratory data, patients with liver diseases can be subdivided into three groups as exhibiting: 1. non-cholestatic liver damage; 2. cholestatic liver damage and 3. liver damage of vascular origin.The first part of the review discusses multiple alterations in the hemostasis system in patients with noncholestatic liver diseases, which are commonly accompanied by hypocoagulation.
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Affiliation(s)
- V. I. Reshetnyak
- A. I. Evdokimov Moscow State University of medicine and dentistry, Ministry of Health of Russia
| | - I. V. Maev
- A. I. Evdokimov Moscow State University of medicine and dentistry, Ministry of Health of Russia
| | | | - S. V. Zhuravel
- N. V. Sklifosovsky Research Institute of Emergency Care, Moscow Healthcare Department
| | - V. M. Pisarev
- V. A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology
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Eisenbrey JR, Dave JK, Halldorsdottir VG, Merton DA, Miller C, Gonzalez JM, Machado P, Park S, Dianis S, Chalek CL, Kim CE, Baliff JP, Thomenius KE, Brown DB, Navarro V, Forsberg F. Chronic liver disease: noninvasive subharmonic aided pressure estimation of hepatic venous pressure gradient. Radiology 2013; 268:581-8. [PMID: 23525208 DOI: 10.1148/radiol.13121769] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To compare subharmonic aided pressure estimation (SHAPE) with pressure catheter-based measurements in human patients with chronic liver disease undergoing transjugular liver biopsy. MATERIALS AND METHODS This HIPAA-compliant study had U.S. Food and Drug Administration and institutional review board approval, and written informed consent was obtained from all participants. Forty-five patients completed this study between December 2010 and December 2011. A clinical ultrasonography (US) scanner was modified to obtain SHAPE data. After transjugular liver biopsy with pressure measurements as part of the standard of care, 45 patients received an infusion of a microbubble US contrast agent and saline. During infusion, SHAPE data were collected from a portal and hepatic vein and were compared with invasive measurements. Correlations between data sets were determined by using the Pearson correlation coefficient, and statistical significance between groups was determined by using the Student t test. RESULTS The 45 study patients included 27 men and 18 women (age range, 19-71 years; average age, 55.8 years). The SHAPE gradient between the portal and hepatic veins was in good overall agreement with the hepatic venous pressure gradient (HVPG) (R = 0.82). Patients at increased risk for variceal hemorrhage (HVPG ≥ 12 mm Hg) had a significantly higher mean subharmonic gradient than patients with lower HVPGs (1.93 dB ± 0.61 [standard deviation] vs -1.47 dB ± 0.29, P < .001), with a sensitivity of 100% and a specificity of 81%, indicating that SHAPE may be a useful tool for the diagnosis of clinically important portal hypertension. CONCLUSION Preliminary results show SHAPE to be an accurate noninvasive technique for estimating portal hypertension.
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Affiliation(s)
- John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, 7 Main, Suite 763, 132 S 10th St, Philadelphia, PA 19107, USA
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Dave JK, Halldorsdottir VG, Eisenbrey JR, Merton DA, Liu JB, Zhou JH, Wang HK, Park S, Dianis S, Chalek CL, Lin F, Thomenius KE, Brown DB, Forsberg F. Investigating the efficacy of subharmonic aided pressure estimation for portal vein pressures and portal hypertension monitoring. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:1784-98. [PMID: 22920550 PMCID: PMC3576693 DOI: 10.1016/j.ultrasmedbio.2012.06.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 06/19/2012] [Accepted: 06/29/2012] [Indexed: 05/14/2023]
Abstract
The efficacy of using subharmonic emissions from Sonazoid microbubbles (GE Healthcare, Oslo, Norway) to track portal vein pressures and pressure changes was investigated in 14 canines using either slow- or high-flow models of portal hypertension (PH). A modified Logiq 9 scanner (GE Healthcare, Milwaukee, WI, USA) operating in subharmonic mode (f(transmit): 2.5 MHz, f(receive): 1.25 MHz) was used to collect radiofrequency data at 10-40% incident acoustic power levels with 2-4 transmit cycles (in triplicate) before and after inducing PH. A pressure catheter (Millar Instruments, Inc., Houston, TX, USA) provided reference portal vein pressures. At optimum insonification, subharmonic signal amplitude changes correlated with portal vein pressure changes; r ranged from -0.82 to -0.94 and from -0.70 to -0.73 for PH models considered separately or together, respectively. The subharmonic signal amplitudes correlated with absolute portal vein pressures (r: -0.71 to -0.79). Statistically significant differences between subharmonic amplitudes, before and after inducing PH, were noted (p ≤ 0.01). Portal vein pressures estimated using subharmonic aided pressure estimation did not reveal significant differences (p > 0.05) with respect to the pressures obtained using the Millar pressure catheter. Subharmonic-aided pressure estimation may be useful clinically for portal vein pressure monitoring.
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Affiliation(s)
- Jaydev K. Dave
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104, USA
| | - Valgerdur G. Halldorsdottir
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104, USA
| | - John R. Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Daniel A. Merton
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Jian-Hua Zhou
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Hsin-Kai Wang
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | | | | | | | - Feng Lin
- GE Global Research, Niskayuna NY 12309, USA
| | | | - Daniel B. Brown
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA
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