Prognostic Value of the Combination of Aortic Pulsatility Index and Fibrosis-4 Index in Patients Admitted for Acute Decompensated Heart Failure

Backgrounds: Aortic pulsatility index (API), calculated as (systolic - diastolic blood pressure)/pulmonary capillary wedge pressure, is a novel hemodynamic measurement representing cardiac filling pressures, and contractility and has been shown to be associated with adverse clinical outcome in patients with advanced heart failure (HF). On the other hand, cardiohepatic interactions have been a focus of attention in HF, and liver dysfunction in HF patients is caused by liver congestion, which is related to liver stiffness. It has been recently reported that liver stiffness assessed by non-invasive fibrosis marker such as Fibrosis-4(FIB4) index predicts the poor outcome in HF patients. However, there is no information available on the prognostic value of the combination of API and FIB4 index in patients with acute decompensated heart failure (ADHF). Methods and Results: We studied 238 patients admitted for ADHF, who underwent right heart catheterization at the admission and were discharged with survival. API was obtained at the admission. FIB4 index was calculated by the formula: age(yrs) х AST[U/L]/(platelets [10 9 /L] х (ALT[U/L]) 1/2 ). FIB4 index >2.67 was defined as abnormal, as previously reported. During a follow up period of 5.2±4.4 yrs, 58 patients had cardiovascular death (CVD). At multivariate Cox analysis, API and FIB4 index were significantly associated with CVD, independently of serum creatinine level and prior heart failure hospitalization, after the adjustment with hemoglobin and serum albumin levels. The patients with both lower API ≤1.905 (AUC 0.665[0.584-0.546]) and abnormal FIB4 index had a significantly increased risk of CVD than those with either lower API or abnormal FIB4 index and none of them (50% vs 23% vs 16%, p=0.0003, respectively). Conclusion: The combination of API and FIB4 index might be useful for stratifying ADHF patients at higher risk for CVD.