Hepatic Congestion Grading (Echo Doppler based) Calculator

Hepatic Congestion Grading (Echo Doppler based): Explanation and Clinical Context Hepatic congestion grading uses Doppler assessment of hepatic vein flow (S wave / D wave ratio) and inferior vena cava (IVC) diameter to quantify venous congestion. The S/D ratio reflects right atrial pressure and hepatic venous compliance, while IVC diameter indicates systemic venous overload. Grade 0 (no congestion) is indicated by normal S/D ratio (> 1) and IVC < 20 mm, representing normal venous return.

Grade 1 (mild congestion) occurs when S/D ratio is 0.5–1 with IVC < 20 mm, indicating early hepatic venous congestion. Grade 2 (moderate congestion) is defined by S/D ratio <0.5 with IVC < 20 mm, suggesting significant hepatic congestion with potential right heart dysfunction. Grade 3 (severe congestion) occurs with dilated IVC >20 mm, reflecting high right atrial pressure and advanced hepatic congestion.

This tool assists clinicians in detecting subclinical congestion, guiding volume management, and monitoring patients with right heart failure or pulmonary hypertension.