Abstract Body (Do not enter title and authors here): Background
The VExUS score is a useful tool for assessing systemic venous congestion that has shown the ability to predict acute kidney injury (AKI) in various populations (post cardiac surgical, CKD & ACS patients). Among the variables included in VExUS, inferior vena cava diameter (IVCD) is of particular importance, as the finding of a non-dilated IVCD (<20 mm) assigns a VExUS score of 0 (indicating no venous congestion). However, multiple factors in addition to congestion status may affect the IVCD, which may result in an errouneous assessment of congestion. Previous studies have suggested that portal vein pulsatility index (PVPI) and renal vein doppler are associated with volume status; however, no previous studies have assessed the PVPI, independently of IVCD, in the prediction of AKI.

Hypothesis
We hypothezise that PVPI may predict AKI independently of the IVCD in patients with AHF.

Methods
A prospective, single-center study was conducted, including patients admitted to the emergency room from July 2023 to January 2024 with the diagnosis of AHF, and in whom VExUS evaluation was performed during the first 8 hours of admission.

For the analysis of the primary endpoint, patients were divided into four groups based on the presence or absence of a dilated inferior vena cava (cutoff <20 mm) and a PVPI ≥30%. We calculated the differences in time to the development of AKI for each group using survival analysis, Log-rank test and depicted the results using Kaplan-Meier curves. All statistical analyses were conducted using STATA v14.1.

Results
A total sample of 189 patients was available for analysis (Figure 1). The mean age was 58.3 years (45.7–70.9), and the proportion of men was 73.6% (137), 5.9% patients had CKD stage IV (n = 11) and 18.8% CHF (n = 35). The median of serum creatinine at admission was 1.1 mg/dL (0.8 – 1.56) and NT-proBNP 4422 (1266 – 10783).

Conclusion
PVPI, independent of dilatation of IVC, is a predictor of AKI in patients with AHF.