Doppler ultrasound-based quantitative assessment of inspiratory effort’s impact on hepatic venous blood return_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WANG Jun ¹ , GAN Pan ¹ , XU Haoming ² , ZHANG Wenyu ¹ , NIU Jingzi ¹ , GUO Shufen ¹ ,  WANG Jinrong ¹

1. Department of Critical Care Medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, Hebei 053000, P.R. China;
2. Department of Geriatric Respiratory, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China;

Corresponding?author：

WANG Jinrong, Email: iamwjr306@163.com

Keywords：

Cardiopulmonary interaction; hepatic venous Doppler; inspiratory effort

DOI：

10.7507/1671-6205.202507073

Video：

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Objective To evaluate hepatic venous Doppler parameters under varying inspiratory effort levels in healthy adults using ultrasound, providing a theoretical basis for assessing the impact of inspiratory effort on hepatic venous blood return. Methods A cross-sectional study was conducted from December 2024 to March 2025, enrolling 61 healthy adults. Inspiratory effort was quantified via portable pulmonary function testing, measuring inspiratory volume (IV) during quiet breathing, moderate inspiratory effort, and maximal inspiratory effort. Hepatic venous Doppler parameters (a-wave, s-wave, d-wave peak velocities) were assessed bedside under these three conditions. Correlation analyses and linear regression models were used to explore relationships between IV and hepatic venous flow parameters. Results A total of 61 participants completed screening, with a mean age of 27.03 ± 4.73 years (24 males, 39.0%). Although male participants had advantages in height and weight, no significant differences in inspiratory volume (IV), hepatic venous a-wave, s-wave, d-wave peak velocities, or s/d ratio were observed between men and women across all breathing states (all P>0.05). Significant negative correlations were identified between IV and a-wave (r=?0.68, 95%CI: ?0.75 to ?0.59), s-wave (r=?0.56, 95%CI: ?0.65 to ?0.45), and d-wave (r=?0.33, 95%CI: ?0.46 to ?0.20) velocities. Linear regression equations were established as follows:a-wave (cm/s) = 22.06 - 0.23 × IV (ml/kg ideal body weight); s-wave (cm/s) = 34.96 - 0.26 × IV (ml/kg ideal body weight); d-wave (cm/s) = 25.82 - 0.11 × IV (ml/kg ideal body weight).The s/d ratio decreased significantly with increasing inspiratory effort (1.37 ± 0.38 vs. 1.23 ± 0.24 vs. 1.15 ± 0.22; F=9.91, P<0.001). However, only a weak negative correlation (r=?0.28, P<0.001) was observed between inspiratory effort and s/d ratio. Conclusion Inspiratory effort demonstrates a strong negative correlation with hepatic venous blood peak flow velocities in healthy adults. While the s/d ratio shows a downward trend with deeper inspiration, the association is weak.

Citation： WANG Jun, GAN Pan, XU Haoming, ZHANG Wenyu, NIU Jingzi, GUO Shufen, WANG Jinrong. Doppler ultrasound-based quantitative assessment of inspiratory effort’s impact on hepatic venous blood return. Chinese Journal of Respiratory and Critical Care Medicine, 2025, 24(12): 866-871. doi: 10.7507/1671-6205.202507073 Copy

1.	Nagueh SF, Kopelen HA, Zoghbi WA. Relation of mean right atrial pressure to echocardiographic and Doppler parameters of right atrial and right ventricular function. Circulation, 1996, 93(6): 1160-1169.
2.	Altinkaya N, Koc Z, Ulusan S, et al. Effects of respiratory manoeuvres on hepatic vein Doppler waveform and flow velocities in a healthy population. Eur J Radiol, 2011, 79(1): 60-63.
3.	王金榮, 鄭喜文, 賀彩, 等. 吸氣努力對液體反應性的影響: 健康青年人預測模型. 國際呼吸雜志, 2023, 43(1): 43-49.
4.	高攀, 李寧, 郭淑芬, 等. 吸氣努力對下腔靜脈內徑變異度的影響. 中國呼吸與危重監護雜志, 2024, 23(7): 465-469.
5.	Cheyne WS, Harper MI, Gelinas JC, et al. Mechanical cardiopulmonary interactions during exercise in health and disease. J Appl Physiol, 2020, 128(5): 1271-1279.
6.	Smeding L, Lust E, Pl?tz FB, et al. Clinical implications of heart-lung interactions, Neth J Med, 2010, 68(2): 56-61.
7.	Beaubien-Souligny W, Rola P, Haycock K, et al. Quantifying systemic congestion with Point-Of-Care ultrasound: development of the venous excess ultrasound grading system. Ultrasound J, 2020, 12(1): 16.
8.	Galarza Barrachina L, Colinas Fernández L, Martín Bermúdez R, et al. Abdominal ultrasound and VExUS score in critical care. Med Intensiva, 2023, 47(11): 658-667.
9.	Argaiz ER. VExUS Nexus: Bedside Assessment of Venous Congestion. Adv Chronic Kidney Dis, 2021, 28(3): 252-261.
10.	Longino AA, Martin KC, Leyba KR, et al. Reliability and reproducibility of the venous excess ultrasound (VExUS) score, a multi-site prospective study: validating a novel ultrasound technique for comprehensive assessment of venous congestion. Crit Care, 2024, 28(1): 197.
11.	Longino A, Martin K, Leyba K, et al. Prospective Evaluation of Venous Excess Ultrasound for Estimation of Venous Congestion. Chest, 2024, 165(3): 590-600.

1. Nagueh SF, Kopelen HA, Zoghbi WA. Relation of mean right atrial pressure to echocardiographic and Doppler parameters of right atrial and right ventricular function. Circulation, 1996, 93(6): 1160-1169.
2. Altinkaya N, Koc Z, Ulusan S, et al. Effects of respiratory manoeuvres on hepatic vein Doppler waveform and flow velocities in a healthy population. Eur J Radiol, 2011, 79(1): 60-63.
3. 王金榮, 鄭喜文, 賀彩, 等. 吸氣努力對液體反應性的影響: 健康青年人預測模型. 國際呼吸雜志, 2023, 43(1): 43-49.
4. 高攀, 李寧, 郭淑芬, 等. 吸氣努力對下腔靜脈內徑變異度的影響. 中國呼吸與危重監護雜志, 2024, 23(7): 465-469.
5. Cheyne WS, Harper MI, Gelinas JC, et al. Mechanical cardiopulmonary interactions during exercise in health and disease. J Appl Physiol, 2020, 128(5): 1271-1279.
6. Smeding L, Lust E, Pl?tz FB, et al. Clinical implications of heart-lung interactions, Neth J Med, 2010, 68(2): 56-61.
7. Beaubien-Souligny W, Rola P, Haycock K, et al. Quantifying systemic congestion with Point-Of-Care ultrasound: development of the venous excess ultrasound grading system. Ultrasound J, 2020, 12(1): 16.
8. Galarza Barrachina L, Colinas Fernández L, Martín Bermúdez R, et al. Abdominal ultrasound and VExUS score in critical care. Med Intensiva, 2023, 47(11): 658-667.
9. Argaiz ER. VExUS Nexus: Bedside Assessment of Venous Congestion. Adv Chronic Kidney Dis, 2021, 28(3): 252-261.
10. Longino AA, Martin KC, Leyba KR, et al. Reliability and reproducibility of the venous excess ultrasound (VExUS) score, a multi-site prospective study: validating a novel ultrasound technique for comprehensive assessment of venous congestion. Crit Care, 2024, 28(1): 197.
11. Longino A, Martin K, Leyba K, et al. Prospective Evaluation of Venous Excess Ultrasound for Estimation of Venous Congestion. Chest, 2024, 165(3): 590-600.

Chinese Journal of Respiratory and Critical Care Medicine

Doppler ultrasound-based quantitative assessment of inspiratory effort’s impact on hepatic venous blood return

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