Abstract 14595: The Clinical Impact of Portal Vein Pulsatility on the Prognosis of Hospitalized Acute Heart Failure Patients

Abstract

Introduction: Heart failure (HF) especially right-heart failure causes hepatic portal system congestion. The Portal vein (PV) pulsatility can be influenced by right atrial pressure (RAP). However, the association between PV pulsatility and the condition of HF remains unclear. Hypothesis: In this study, we aim to evaluate usefulness of PV pulsatility as a prognostic marker as well as a therapeutic indicator for hospitalized acute HF patients. Methods: We enrolled 54 patients with acute HF and 17 patients without HF served as controls. PV flow velocity was measured by ultrasonography at admission and discharge phase. PV pulsatility ratio (PVPR) was calculated by dividing minimal velocity by peak velocity. The primary endpoint for prognostic analysis was cardiac death and unexpected re-hospitalization for recurrent HF. The observation period was one year from first hospitalization for HF. Results: On admission, PVPR was significantly higher in controls compared to acute HF patients (0.91±0.08 vs. 0.71±0.04, p&lt0.01).PVPR did not change during the hospitalization in controls (admission 0.91±0.08 vs discharge 0.93±0.06, p=0.31). However, in acute HF patients, PVPR was significantly elevated after the improvement of HF (admission 0.71±0.04 vs discharge 0.82±0.02, p&lt0.05) due to the increase in minimal velocity (admission 12.6±4.5 cm/s vs. discharge 14.6±4.6 cm/sec, p&lt0.05), indicating the decrease in RAP. To elucidate the association between PVPR and primary endpoint, the patients were divided into three groups according to the tertile of PVPR at discharge (PVPR-Q1:0.92&ltPVPR&lt1, PVPR-Q2: 0.73&ltPVPR&lt0.92, PVPR-Q3:PVPR&lt0.73). Kaplan-Meier analysis found that the patients with higher PV pulsatility at discharge had significantly higher event rate among the groups (Figure). Conclusions: PVPR at discharge would reflect the condition of HF. It also can be a novel prognostic marker for hospitalized acute HF patients.