#78 - Ventriculo-Arterial Coupling and Regional Arterial Flow Redistribution in Previously Decompensated Cirrhosis: A Doppler-Based Proof-of-Concept Study

Introduction and Objectives Decompensated cirrhosis is characterized by systemic/splanchnic vasodilation and reduced effective arterial volume. Ventriculo-arterial coupling (VAC), integrating ventricular performance and arterial load, may better reflect this circulatory derangement than cardiac output alone. To explore the association between VAC and regional arterial Doppler parameters in patients with previously decompensated cirrhosis, as a proof-of-concept approach to mesenteric-renal flow redistribution. Materials and Methods We conducted an exploratory observational study including patients with previously decompensated cirrhosis who underwent echocardiographic and vascular Doppler assessment. VAC was calculated as the ratio between arterial elastance and ventricular elastance. Regional Doppler assessment included velocity-time integral (VTI) and resistance index measurements in the renal artery, superior mesenteric artery (SMA), splenic artery, hepatic artery, and intrarenal arteries when available. Associations between VAC and Doppler-derived parameters were evaluated using Spearman’s rank correlation. The SMA VTI/renal VTI ratio was calculated as a redistribution index. Results Lower VAC was significantly associated with lower renal artery VTI (rho=0.51; p=0.025). SMA VTI showed an inverse correlation with VAC, with a trend toward statistical significance (rho=-0.53; p=0.053). The SMA VTI/renal VTI ratio was significantly and inversely correlated with VAC (rho=-0.65; p=0.012). Cardiac output and cardiac index were not significantly associated with regional VTI measurements. Conclusions Lower VAC was associated with reduced renal VTI and a higher SMA-to-renal VTI ratio, suggesting Doppler-derived regional arterial flow redistribution related to arterial load and ventriculo-arterial uncoupling rather than cardiac output alone.