Portal Vein Pulsatility: A Valuable Approach for Monitoring Venous Congestion and Prognostic Evaluation in Acute Decompensated Heart Failure

The severity of systemic congestion is associated with increased portal vein flow pulsatility (PVP). To determine the usefulness of PVP as a marker of decongestion and prognosis in acute decompensated heart failure (ADHF) patients. 105 patients, 60% of whom were men, were hospitalized with ADHF, and their PVP index (PVPI) was calculated (maximum velocity-minimum velocity/maximum velocity) × 100 on admission and before discharge, along with their EVEREST score, inferior vena cava diameter (IVC), NT-proBNP, serum sodium, and glomerular filtration rate. A PVPI ≥ 50% was defined as a marker of systemic congestion. After treatment with loop diuretics, a decrease in PVPI of >50% before discharge was considered a marker of decongestion The patients were classified into two groups (G): G1-PVPI decrease ≥ 50% (54 patients) and G2-PVPI decrease < 50% (51 patients). At discharge, compared to G2, G1 patients had lower mean PVPI (14.2 vs. 38.9; < 0.001), higher serum Na (138 vs. 132 mmol/L, = 0.03), and a higher number of patients with a significant (>30%) NT-proBNP decrease (42 vs. 27, = 0.007). PVPI correlated with IVC (r = 0.55, < 0.001), NT-proBNP (r = 0.21, = 0.04), and serum Na (r = -0.202, = 0.04). A total of 55% of patients had worsening renal failure (G1 63% vs. G2 48%, = 0.17). After 90 days, G2 patients had higher mortality (27.45% vs. 3.7 = 0.001) and rehospitalization (49.01% vs. 33.33%, < 0.001). In multivariate regression analysis, PVPI was an independent predictor of rehospitalization (OR 1.05, 95% CI 1.00-1.10, = 0.048). Portal vein flow pulsatility, a meaningful marker of persistent subclinical congestion, is related to short-term prognosis in ADHF patients.