Clinical impact of portal vein pulsatility on the prognosis of hospitalized patients with acute heart failure

Abstract

BACKGROUND

Heart failure (HF) causes extracardiac organ congestion, including in the hepatic portal system. Reducing venous congestion is essential for HF treatment, but evaluating venous congestion is sometimes difficult in patients with chronic HF. The portal vein (PV) flow pattern can be influenced by right atrial pressure. Ultrasound images of the PV are quite easy to obtain and are reproducible among sonographers. However, the association between PV pulsatility and the condition of HF remains unclear. We hypothesize that PV pulsatility at discharge reflects the condition of HF.

AIM

To evaluate the usefulness of PV pulsatility as a prognostic marker for hospitalized patients with acute HF.

METHODS

This observational study was conducted from April 2016 to January 2017 and April 2018 to April 2019 at Shinko Hospital. We enrolled 56 patients with acute HF, and 17 patients without HF served as controls. PV flow velocity was measured by ultrasonography on admission and at discharge. We calculated the PV pulsatility ratio (PVPR) as the ratio of the difference between the peak and minimum velocity to the peak velocity. The primary endpoint was cardiac death and HF re-hospitalization. The observation period was 1 year from the first hospitalization. The Kaplan-Meier method was used to determine the stratified composite event-free rates, and the log-rank test was used for comparisons between groups.

RESULTS

On admission, the PVPR was significantly higher in patients with acute HF than controls (HF: 0.29 ± 0.20 vs controls: 0.08 ± 0.07, P < 0.01). However, the PVPR was significantly decreased after the improvement in HF (admission: 0.29 ± 0.20 vs discharge: 0.18 ± 0.15, P < 0.01) due to the increase in minimum velocity (admission: 12.6 ± 4.5 vs discharge: 14.6 ± 4.6 cm/s, P = 0.03). To elucidate the association between the PVPR and cardiovascular outcomes, the patients were divided into three groups according to the PVPR tertile at discharge (PVPR-T1: 0 ≤ PVPR ≤ 0.08, PVPR-T2: 0.08 < PVPR ≤ 0.21, PVPR-T3: PVPR > 0.21). The Kaplan-Meier analysis showed that patients with a higher PVPR at discharge had the worst prognosis among the groups.

CONCLUSION

PVPR at discharge reflects the condition of HF. It is also a novel prognostic marker for hospitalized patients with acute HF.

Keywords: Heart failure; Venous congestion; Atrial pressure; Ultrasonography; Portal vein; Prognosis

Core Tip: Although reducing venous congestion is essential for heart failure (HF) treatment, the assessment of venous congestion is sometimes difficult, especially in patients with recurrent HF. Interestingly, a previous study demonstrated a correlation between right atrial pressure and portal vein (PV) flow pattern. However, the association between PV flow and the condition of HF remains unclear. Therefore, we investigated the clinical usefulness of PV pulsatility in hospitalized patients with HF. We found that PV pulsatility reflected not only the condition of HF but also cardiovascular outcomes. Therefore, PV pulsatility may be a novel prognostic marker for hospitalized patients with HF.