Mohamed Elmallahy, MD1, Arti Anand, MD1, Mahmoud Morsy, MD1, Prasad Rajalingamgari, MD2, Megan Summers, 1, Anoop Narayana Pillai, PhD1, Sergiy Kostenko, PhD1, Biswajit Khatua, PhD1, Christine Snozek, PhD1, Marek Belohlavek, MD, PhD1, Stacie Vela, MD3, Vijay P.. Singh, MD1 1Mayo Clinic, Scottsdale, AZ; 2NYC Health + Hospitals/South Brooklyn Health, Scottsdale, AZ; 3VA Phoenix Medical Center, Phoenix, AZ Introduction: Vascular leak during acute pancreatitis (AP) is assumed to cause severity, making fluid resuscitation the main treatment. However, pulmonary edema complications from fluid overload during the WATERFALL trial suggest underlying LVD. Therefore, we compared early cardiac injury, LVD, and EF% in patients developing SAP vs. those developing mild or moderate acute pancreatitis (MMAP). Methods: Patients presenting with AP to Mayo Clinic Arizona or the Phoenix VA Medical Center between May 2017 and February 2024 were included. Those with pre-existing heart failure, ischemic heart disease, valvular heart disease, chronic pancreatitis, pancreatic cancer, pancreatic surgery, pregnant women, history of stage 4 renal failure or dialysis were excluded. Patients were classified as SAP or MMAP based on the Revised Atlanta Criteria. Fluid status, admission serum CK-MB, NT-Pro BNP, echocardiography, and clinical outcomes were compared between the two groups. Results: Age, sex, race, and BMI were similar between the 23 SAP and the 237 MMAP patients. All SAP patients developed persistent organ failure and 10 required ICU admission (43% vs 0% in MMAP, p=0.0001). Four required pressors (17% vs 0%, p=0.0001), and had longer hospital stay (17 ± 22 vs 3 ± 3 days, p=0.0001) versus MMAP. Compared to MMAP patients, SAP patients had lower mean arterial pressure (90 ± 2 vs 105 ± 16 mmHg). The drop in hematocrit value (%) from the day of admission vs the day of echocardiography (median day 2 in both groups) trended to be higher in SAP (- 8.3 ± 5.5 vs – 4.6 ± 5.9, p=0.09), compared with the MMAP group. SAP patients had lower end-diastolic volume (EDV) (88 ± 31 ml vs 149 ± 160 ml, p</em>=0.03) and lower stroke volume (SV) (57 ± 19 ml vs 70 ± 16 ml, p=0.02), while both groups had preserved %EF (65 ± 9% and 62 ± 5%, p=0.09). SAP patients had higher markers of cardiac injury (CK-MB 46 ± 35 vs 26 ± 14 pg/ml, p=0.03) and higher markers of heart failure (NT-Pro BNP 347 ± 1278 vs 73 ± 618 pg/ml, p=0.002) versus MMAP patients. Discussion: SAP patients have elevated cardiac injury and heart failure markers on admission. Despite adequate fluid resuscitation, SAP patients had lower EDV and SV but normal EF% compared to MMAP. Thus, cardiac injury and left ventricular dysfunction with preserved ejection fraction are present in early SAP. These contribute to the fluid overload, hypotension, and the severity of pancreatitis.
Disclosures: Mohamed Elmallahy indicated no relevant financial relationships. Arti Anand indicated no relevant financial relationships. Mahmoud Morsy indicated no relevant financial relationships. Prasad Rajalingamgari indicated no relevant financial relationships. Megan Summers indicated no relevant financial relationships. Anoop Narayana Pillai indicated no relevant financial relationships. Sergiy Kostenko indicated no relevant financial relationships. Biswajit Khatua indicated no relevant financial relationships. Christine Snozek indicated no relevant financial relationships. Marek Belohlavek indicated no relevant financial relationships. Stacie Vela indicated no relevant financial relationships. Vijay Singh indicated no relevant financial relationships.
Mohamed Elmallahy, MD1, Arti Anand, MD1, Mahmoud Morsy, MD1, Prasad Rajalingamgari, MD2, Megan Summers, 1, Anoop Narayana Pillai, PhD1, Sergiy Kostenko, PhD1, Biswajit Khatua, PhD1, Christine Snozek, PhD1, Marek Belohlavek, MD, PhD1, Stacie Vela, MD3, Vijay P.. Singh, MD1. P2227 - Severe Acute Pancreatitis (SAP) Is Associated With Left Ventricular Dysfunction With Preserved Ejection Fraction, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
