Episcleral Venous Tortuosity Indicates Increased Ventricular Filling Pressure in Heart Failure with Reduced Ejection Fraction

Özet

Objectives: In chronic venous hypertension (HT), the adaptation of smooth muscle-poor veins typically occurs with corkscrew-like morphology. The observation of episcleral venous tortuosity (EVT) seems to be a simple and important method for the detection of chronic venous HT using the eye. Whether EVT can provide knowledge about left ventricular (LV) end diastolic pressure via the surrogate marker of lateral ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/E’) in heart failure (HF) with reduced ejection fraction (HFrEF) is unknown. Materials and Methods: The study included 200 cases of HFrEF and 200 control subjects with normal ejection fractions and similar ages (59.3±7.6 and 58.6±6.8 years, respectively) and sex distribution. EVT was determined using a simple visual light source. Echocardiographic parameters were measured using accepted methods. Results: EVT was found in 43 (21.5%) cases in the HFrEF group and 15 (7.5%) subjects in the control group. In the control group, areas under receiver operating characteristic curves for the LV lateral E/E’ (>10.5), right ventricular (RV) lateral E/E’ (>5.5), and LV mass index (>115 g/m2) distinguished subjects with and without EVT (p 15.25), RV E/E’ (>12.2), tricuspid annular plane systolic excursion (TAPSE); ˂1.45, LV mass index (>106 g/m2), atrial fibrillation, and presence of long-term HF. Conclusion: Tortuosity in episcleral veins in patients with HFrEF can predict the LV lateral E/E’ (>15.25), RV E/E’ (>12.2), TAPSE (˂1.45), and LV mass index (>106 g/m2) with sensitivity (65.1%, 30.2%, 74.4%, and 53.5%, respectively) and specificity (96.8%, 97.4%, 62.4%, and 77.1%, respectively).