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Publications

Journal Article Ahead of print

PubMed: 42895733 DOI: 10.1093/ehjqcco/qcag149

The complexity of congestion in heart failure: a critical review of the evidence and a proposal for a multimodality approach.

Eur Heart J Qual Care Clin Outcomes

Authors: Alberto Palazzuoli, Nicolas Girerd, Massimo Piepoli, Andrew P Ambrosy, Guillaume Baudry, Juan Carlos Lopez-Azor, Mateusz Guzik, Òscar Miró, Jeroen Dauw, Gracian Iwanek, Peder Myhre, Marta Cobo Marcos, Masatake Kobayashi, Jan Biegus

Affiliations

  • Cardiovascular Diseases Unit, Cardio-Thoracic and Vascular Department Le Scotte Hospital University of Siena, Viale Bracci 12, Siena 53100, Italy.
  • CHRU de Nancy, Centre D'Investigation Clinique Plurithématique 1433, INSERM, Université de Lorraine, INSERM U116-DCAC, and F-CRIN iNI-CRCT (Cardiovascular and Renal Clinical Trialists), 4 Rue du Morvan, Vandœuvre-lès-Nancy 54511, France.
  • Cardiology University Department, IRCCS Policlinico San Donato, Milan 20097, Italy.
  • Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA 94115, USA.
  • Divison of Research, Kaiser Permanente Northern California, Pleasanton, CA 94115, USA.
  • Departamento de Cardiologia, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid 28222, Spain.
  • Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Heart Failure and Inherited Cardiac Diseases, Cardiology Department, Madrid 28041, Spain.
  • Centro de Investigacion Biomedica en Red de Enfermedades Cardiovasculares (CIBERCV), Majadahonda, Madrid 28029, Spain.
  • Department of Cardiology, Clinical Department of Intensive Cardiac Care, Wroclaw Medical University, Faculty of Medicine, Institute of Heart Diseases, Borowska 213, Wroclaw 50-556, Poland.
  • Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia 08036, Spain.
  • Cardiovascular Center Aalst, AZORG Hospital, Aalst 9300, Belgium.
  • Department of Cardiology, Oslo University Hospital Rikshospitalet and University of Oslo, Oslo 0372, Norway.
  • Department of Cardiology, Tokyo Medical University, Tokyo 160-8402, Japan.
  • Jan Mikulicz Radecki University Hospital in Wrocław, Department of Cardiology, Borowska 213, Wroclaw 50-556, Poland.

Abstract

Congestion remains the first cause of hospitalization in acute heart failure patients, and it is the primary goal of treatment during early phases of hospitalization. Despite its clinical relevance, a universal algorithm for quantification or characterization is lacking. Indeed, congestion has been differently evaluated across several studies in terms of timing checks and diagnostic methods. Recent analyses have highlighted the importance of differentiating between intravascular and tissue congestion. Although it is associated with haemodynamic dysfunction, extravascular congestion may occur even in the absence of overt intravascular fluid overload. Importantly, tissue congestion is not merely a reflection of intravascular volume expansion. In this framework, the interstitial space surrounding the capillary barrier and its integrity may be accounted as additive drivers for tissue congestion. In clinical practice, this distinction remains anchored in simplistic clinical assessment, and poorly evaluated. A critical review of the evidences has been performed and multimodal approaches combining ultrasonography, invasive measurements, and biomarkers have been proposed.

MeSH

Hospitalization, Heart Failure, Heart, Cardiovascular Diseases, Tissues