Dynamic monitoring of left ventricular vortex flow by bedside ultrasound: Analysis of risk factors for left heart J wave and new standards for hemodynamic assessment

Background: In critically ill patients, hemodynamic changes arise from complex cardiac flow dynamics. Research has demonstrated a correlation between left ventricular vortices and different clinical factors. It's really important to assess intracardiac fluid dynamics in real-time. This study used echocardiography to capture vortices (i.e., J waves) in the left ventricular outflow tract and conducted multivariable analysis on clinical data to explore the factors influencing their formation and assess the clinical value of J wave quantitative indicators. Methods: We conducted a review of 197 critically ill patients admitted to the emergency ICU at Cangzhou Central Hospital between June 2024 and February 2025. Echocardiography results and patient information were recorded. We also monitored lab data from the day of the echocardiogram during the patients' hospital stay. Patients were classified based on the presence or absence of left ventricular J waves. Results: Our analysis found a significant link between organ dysfunction (including respiratory failure, altered consciousness, and acute kidney injury), inflammatory markers (such as leukocytes/interleukin-6), and Biochemical indicators (such as albumin) and left ventricular vortices ( P <0.05). The logistic regression model demonstrated strong predictive power, achieving an area under the curve (AUC) of 0.845. Additionally, the quantitative indicator of J VTI had independent predictive value for ejection fraction (EF) over 50% (AUC of 0.799). Furthermore, J VTI showed a positive correlation with several echocardiographic measurement parameters, such as LVOT VTI ( r =0.497, P <0.001), EPG ( r =0.430, P <0.001), and E peak ( r =0.425, P <0.001). Conclusion: Our findings indicate that the formation of J waves reflects ventricular vortices, underscoring the importance of echocardiography for both qualitative and quantitative assessments of cardiac flow.