ArticleAnnals of intensive care2025
Decoding portal vein pulsatility: hemodynamic determinants in a post-hoc analysis of a prospective observational trial.
Article in Annals of intensive care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06440772 (Assessing Fluid Intolerance Using Portal Vein Pulsatility Index Post-Passive Leg Raising Test in Fluid Responders), which is not on this map. Cited by 5 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Assessing Fluid Intolerance Using Portal Vein Pulsatility Index Post-Passive Leg Raising Test in Fluid Responders: A Prospective Cohort Study
Who cites it
5 citing papers in PubMed.
- Integrated haemodynamic monitoring of fluid responsiveness and fluid tolerance in critical care: from physiology to bedside applications.Journal of clinical monitoring and computing · 2026Review
- A Guyton-based hypothesis for venous congestion.The ultrasound journal · 2026Article
- Rethinking Congestion in Heart Failure from Volume Overload to Venous Pressure and Organ Disfunction with VExUS.Medicina (Kaunas, Lithuania) · 2026Review
- VExUS score: optimizing its use in perioperative and critical care management.Critical care (London, England) · 2025Review
- Venous congestion and the geometry of Guyton.Annals of intensive care · 2025Article
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Authors and funding
14 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe portal vein pulsatility index (PVPI) reflects systemic congestion and is influenced by both volume status and right ventricular (RV) function. The mean systemic filling pressure analogue (Pmsa), derived from a mathematical model, estimates the interaction between stressed blood volume and systemic vascular compliance, serving as surrogate marker of volume status. This post-hoc analysis of an observational trial investigates the combined role of Pmsa and RV function as determinants of PVPI using echocardiography. Fifty-five mechanically ventilated patients with circulatory failure were included within 6 h of ICU admission following elective open-heart surgery. Fluid-tolerant patients (PVPI < 50%) underwent a passive leg raising (PLR) test; fluid-responsive patients subsequently received 7 mL/kg of Ringer's lactate. PVPI and Pmsa were measured at five timepoints: baseline (T1), after PLR (T2), upon returning to baseline (T3), after fluid administration (T4), and 20 min post-infusion (T5). RV function parameters, including RV to LV end-diastolic area ratio (RVEDA/LVEDA), tricuspid lateral annular systolic velocity (RV S'), RV fractional area change (RVFAC), pulmonary acceleration time (PAT), and right myocardial performance index (RIMP)-were assessed at T1, T4, and T5. Only fluid-responsive patients were evaluated beyond T3.
resultsAt T1, robust multilinear regression including all patients identified RVEDA/LVEDA (β = 10.38; p < 0.001), RIMP (β = - 6.54; p = 0.002), and RV S' (β = - 0.60; p = 0.002) as significant determinants of squared PVPI. In all patients, repeated measures correlation between Pmsa and PVPI was strong across T1-to-T3 (ρ = 0.785; p < 0.001), increasing from a non-significant correlation at T1 (ρ = 0.215; p = 0.115). Generalized estimating equations conducted only in fluid-responsive patients across T1, T4, and T5 identified Pmsa (β = 4.19; p < 0.001), RV S' (β = - 5.84; p < 0.001), RVEDA/LVEDA (β = 34.85; p = 0.018), and RIMP (β = - 35.28; p = 0.039) as significant determinants of PVPI.
conclusionRV function and Pmsa are key determinants of PVPI. Their combined assessment may support an individualized congestion management by guiding interventions toward volume status, RV function, or both. Trial registration Primary Trial Registration: NCT06440772. Registered 30 May 2024. Retrospectively registered.
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