Intra-abdominal pressure and perfusion pressure in acute decompensated heart failure: clinical and prognostic insights

Abdominal venous congestion is increasingly recognized as an important contributor to clinical deterioration in acute decompensated heart failure (ADHF). Intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) may provide complementary insights into systemic congestion and organ perfusion; however, their prognostic value in ADHF remains undefined. To evaluate the prognostic value of IAP and APP in patients with acute decompensated heart failure. This prospective observational study enrolled 110 consecutive patients hospitalized with ADHF. IAP was measured using a standardized transvesical technique within the first 24 h of admission, and intra-abdominal hypertension (IAH) was defined as an IAP ≥ 12 mmHg. APP was calculated as mean arterial pressure minus IAP. Clinical, echocardiographic, and laboratory characteristics were recorded. Mortality and rehospitalization at 1, 6, and 12 months were assessed, and multivariable regression analyses were performed to identify independent predictors of adverse outcomes. IAH was present in 29.1% of patients. Compared with patients without IAH, those with IAH had lower diastolic and mean arterial pressures, larger right atrial dimensions, and worse renal function. Elevated IAP was associated with significantly higher mortality at 1, 6, and 12 months, as well as increased rehospitalization rates during follow-up. In multivariable analyses, elevated IAP remained an independent predictor of mortality and rehospitalization, whereas higher APP was associated with more favorable early outcomes. Elevated IAP is an independent predictor of adverse outcomes in ADHF, while APP provides complementary prognostic information. Integrating both congestion- and perfusion-related parameters may improve risk stratification and guide targeted decongestive strategies.