Diagnostic Value Of Common Femoral Vein Pulsatile Spectrum For Assessment Of Right Ventricular Dysfunction

Objective:By evaluating the spectral characteristics of common femoralvein(CFV)of lower extremity in patients with right ventricular insufficiency,and analyzing the frequency of pulsatile spectrum of common femoral vein and the range of right heart pressure corresponding to its occurrence,it was found that the The diagnostic value of venous pulsatile spectrum on right ventricular pressure is expected to provide a convenient method for clinical judgment of right ventricular dysfunction.Methods: A total of 45 patients who were diagnosed with tricuspid regurgitation and pulmonary hypertension during cardiac ultrasound examination in our hospital from April 2021 to November 2021 were collected as the experimental group.According to the right ventricular systolic pressure(RVSP)during systole is approximately equal to the pulmonary artery systolic pressure(PASP),RVSP=4×maximal tricuspid regurgitation velocity~2+RAP.The maximum tricuspid regurgitation velocity was measured by serial Doppler,and the right atrial pressure(RAP)was estimated using the diameter of the inferior vena cava(IVC)and the respiratory collapse rate of the inferior vena cava.According to their pulmonary artery systolic pressure(PASP)and right atrial pressure(RAP)classification,the patients were divided into mild right heart pressure group(PASP 35-50 mm Hg,RAP 3mm Hg,15 cases),moderate right heart pressure group(PASP 50-70 mm Hg),RAP 8mm Hg,15 cases),severe right heart pressure group(PASP>70mm Hg,RAP 15 mm Hg,15 cases).In addition,45 patients with normal echocardiography during the same period were selected as the control group.Both groups of experimenters performed cardiac ultrasonography: measurement of continuous Doppler measurement of maximum tricuspid regurgitation velocity,IVC inner diameter,IVC respiratory collapse rate,and the presence or absence of pericardial effusion.Then perform Doppler scan of the common femoral vein of the lower extremity,observe the spectral shape of the common femoral vein during the cardiac cycle,record the normal respiratory variability and the response to Valsalva enhancement action,and measure the reverse a-wave velocity if there is a pulsatile spectrum.Finally,a scan of the pleural cavity and ascites was performed.The presence or absence of common femoral vein pulsatile spectrum in the control group was observed,and the frequency of common femoral vein pulsatile spectrum under different right heart pressure groups and the corresponding right heart pressure range were analyzed.The relationship between theoccurrence of CFV pulsatile spectrum and the occurrence of pleural,abdominal and pericardial effusions in the experimental group was analyzed.Results:(1)There was no pulsatile spectrum in the common femoral vein in the control group;there was no pulsatile spectrum in the common femoral vein in the experimental mild group.(2)The results of Spearman correlation analysis showed that the correlation coefficient between the pressure value corresponding to the moderate right heart pressure group and the pulsatile spectrum was 0.655,the P value was 0.008,and P < 0.05,indicating that there was a positive correlation between them,and according to The correlation coefficient is 0.655,indicating that the two are strongly correlated;the correlation coefficient between the severe group and the corresponding pressure value pulsatile spectrum is 0.733,the P value is 0.002,and P>0.05,indicating that there is a positive correlation between them,and According to the correlation coefficient,both are strongly correlated.(3)The receiver operating characteristic curve(ROC)was used to confirm the cutoff value.In the case of no stratification,when the estimated right atrial pressure was ≥8 mm Hg,the pulmonary artery pressure value of54.85 mm Hg was the cutoff of the pulsatile spectrum.value.Elevated right cardiac pressure was a strong predictor of the occurrence of pulsatile spectrum,and the area under the ROC curve(AUC)in different groups was above 0.9.In the moderate-severe group,the sensitivity was 0.947,and the specificity was 0.818.In the severe group,when the right atrial pressure was estimated to be ≥15 mm Hg,the pulmonary artery pressure was 70.9 mm Hg as the cut-off value,which could achieve complete detection of the pulsatile spectrum.The sensitivity is 0.9 and the specificity is 1.(4)In the moderate group,the correlation coefficient between the pulmonary arterial pressure and the reverse a-wave velocity of the common femoral vein was 0.663,the P value was0.007,and P<0.05,indicating that there was a positive correlation between them.The correlation coefficient between pulmonary artery pressure and a-wave velocity value in severe group was 0.481,P value was 0.07,P>0.05,indicating that there was no correlation between them.(5)The results of Spearman correlation analysis showed that the correlation coefficient between the pulsatile spectrum and pleural effusion in the moderate and above groups was 0.705,and the P value was <0.001,indicating that there was a positive correlation betweenthem,and according to the correlation coefficient,it was a strong correlation;The correlation coefficient between the appearance of pulsatile spectrum and ascites is 0.377,and the P value is less than 0.05,indicating that there is a positive correlation between them.According to the correlation coefficient,it is a general correlation;No correlation。Conclusion:(1)The femoral vein pulsatile spectrum has no significant effect on predicting mildly elevated right ventricular pressure;(2)When the estimated right atrial pressure is ≥8 mm Hg and the pulmonary artery systolic pressure is greater than 50.85 mm Hg,the common femoral vein pulsatile spectrum will be significantly increased.Appears,lower extremity pulsatile spectrum can predict moderate or higher pulmonary artery systolic pressure and right atrial pressure,reflecting right ventricular dysfunction;(3)The velocity value of reverse a wave in the pulsatile spectrum does not vary with right ventricular pressure and right atrial pressure.The atrial pressure increases,so the velocity value cannot predict the degree of right ventricular insufficiency;(4)the common femoral vein pulsatile spectrum is accompanied by systemic symptoms of right ventricular insufficiency,including pleural effusion and ascites.