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Portal congestion and intestinal edema in hospitalized patients with heart failure

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Abstract

An interaction between the intestine and cardiovascular disease has been suggested. We thought to clarify the association between intestinal conditions and clinical outcomes in patients with heart failure (HF). Hemodynamic parameters in intestinal vessels [superior mesenteric artery (SMA), inferior mesenteric artery (IMA), and portal vein (PV)] and average colon wall thickness (aCWT) from the ascending colon to sigmoid colon were evaluated in 224 hospitalized HF patients. Echocardiographic parameters and composite event rates (all-cause mortality, readmission for HF deterioration, major ventricular arrhythmias) were also examined. Higher PV congestion index (CI) and aCWT were observed in patients with New York Heart Association (NYHA) class III/IV. Higher PVCI [hazard ratio (HR) per + 1 standard deviation (SD) 1.50, p < 0.01] and aCWT (HR per + 1 SD 1.45, p < 0.01) were independently associated with higher composite event rates during the follow-up of 122 ± 68 days. None of SMA/IMA hemodynamic parameters were associated with NYHA class or composite event rates. Higher right ventricular end-diastolic dimension (38 ± 7 vs 34 ± 9 mm, p < 0.01) and lower tricuspid annual plane systolic excursion (15 ± 5 vs 19 ± 5 mm, p < 0.001) were observed in patients with higher PVCI (> 0.031 cm s) and aCWT (> 2.8 mm) relative to those in others. In conclusion, increased portal congestion and intestinal edema were associated with severe HF symptoms and poor outcomes in hospitalized HF patients, in addition to being associated with impaired right-sided cardiac function.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan

    Yuki Ikeda, Shunsuke Ishii, Mayu Yazaki, Teppei Fujita, Yuichiro Iida, Toyoji Kaida, Takeru Nabeta, Emi Maekawa, Tomoyoshi Yanagisawa, Toshimi Koitabashi & Junya Ako

  2. Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan

    Eiji Nakatani

  3. Department of Cardiovascular Medicine, Kitasato Institute Hospital, Tokyo, Japan

    Takayuki Inomata

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  1. Yuki Ikeda
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  2. Shunsuke Ishii
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Ikeda, Y., Ishii, S., Yazaki, M. et al. Portal congestion and intestinal edema in hospitalized patients with heart failure. Heart Vessels 33, 740–751 (2018). https://doi.org/10.1007/s00380-018-1117-5

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