Congestion is an important diagnostic and therapeutic target in heart failure.
Most hospitalizations for acute heart failure syndrome (AHFS) are related to clinical congestion as a result of high left ventricular diastolic pressure (LVDP) rather than to low cardiac output. Patients frequently develop "hemodynamic congestion" (high LVDP) several days to weeks before the onset of symptoms and signs of clinical congestion. By the time symptoms and signs are evident, patients generally require hospitalization. High LVDP increases left ventricular (LV) wall stress and possibly contributes to neurohormonal activation and LV remodeling, thereby contributing to progression of heart failure (HF). Congestion is a major predictor of both morbidity and mortality in HF. Some methods may aid in the evaluation of silent hemodynamic congestion, but these assessment tools are generally underused. Identification of hemodynamic congestion, before the clinical manifestations appear, may potentially prevent hospitalization and slow the progression of HF by allowing life-saving interventions to be implemented sooner.
Gheorghiade
Mihai
M
Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Shin
David D
DD
Thomas
Tarita O
TO
Brandimarte
Filippo
F
Fonarow
Gregg C
GC
Abraham
William T
WT
D000208:Acute Disease; D002302:Cardiac Output; D004232:Diuretics / Q000627:therapeutic use*; D042241:Early Diagnosis; D004452:Echocardiography; D004489:Edema, Cardiac / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D006333:Heart Failure / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D006760:Hospitalization; D006801:Humans; D010808:Physical Examination; D011379:Prognosis; D011654:Pulmonary Edema / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D011669:Pulmonary Wedge Pressure; D011859:Radiography; D012042:Registries; D013577:Syndrome; D016277:Ventricular Function, Left
D004232:Diuretics