title: Lung congestion in chronic heart failure: haemodynamic, clinical, and prognostic implications.
abstract: OBJECTIVE
  The goal of the study was to examine the prognostic impact, haemodynamic and clinical features associated with lung congestion in patients with chronic heart failure (HF).
  
  
  RESULTS
  HF patients (n = 186) and HF-free controls (n = 21) underwent right heart catheterization, echocardiography, pulmonary function testing and chest radiography that was blindly scored for the presence and severity of lung oedema. Lung congestion correlated directly with pulmonary vascular resistance (PVR, P = 0.004) and inversely with pulmonary artery (PA) compliance (P < 0.001) and the diffusion limit for carbon monoxide (DLCO , P = 0.009). Compared with dry lung HF, wet lung HF patients (congestion score > median) had 25% lower PA compliance and 25-35% higher PVR, transpulmonary gradients and PA pressures (40 vs. 32 mmHg, P < 0.001) despite marginally higher PA wedge pressure (PAWP; 22 vs. 19 mmHg, P = 0.002). Wet lung HF patients displayed more right ventricular (RV) dilatation and dysfunction, more restrictive ventilation and greater reduction of DLCO . The strongest correlates of lung congestion were NT-proBNP, haemoglobin, albumin, and glomerular filtration, all surpassing PAWP. After a median of 333 days (interquartile range 80-875), 59 patients (32%) died. Lung congestion was associated with reduced survival (P < 0.0001), even after adjusting for PAWP, NT-proBNP, anaemia, CAD and renal dysfunction.
  
  
  CONCLUSIONS
  Interstitial lung oedema is associated with pulmonary vascular disease, RV overload and dysfunction and increased mortality in HF. These data reinforce the importance of aggressive decongestion in HF and suggest that novel agents aimed at reducing lung water may help to deter progression of pulmonary vascular disease and biventricular HF.
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA.|Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic.
authors.forename: Vojtech
authors.initials: V
authors.lastname: Melenovsky
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA.|Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Mads J
authors.initials: MJ
authors.lastname: Andersen
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic.
authors.forename: Krystof
authors.initials: K
authors.lastname: Andress
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Yogesh N
authors.initials: YN
authors.lastname: Reddy
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Barry A
authors.initials: BA
authors.lastname: Borlaug
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods; D004452:Echocardiography / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011654:Pulmonary Edema / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D011859:Radiography; D012129:Respiratory Function Tests / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013223:Statistics as Topic; D016019:Survival Analysis; D014481:United States; D014655:Vascular Resistance; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology*
keywords: Congestion; Haemodynamics; Heart failure; Pulmonary oedema; Pulmonary vascular resistance; Right heart