Congestion Is an Important Diagnostic and Therapeutic Target in Heart Failure
Mihai Gheorghiade *, David D. Shin *, Tarita O. Thomas *, Filippo Brandimarte †, Gregg C. Fonarow ‡, William T. Abraham §
1 Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
2020 Department of Cardiovascular, Respiratory and Morphological Sciences, University of Rome La Sapienza, Rome, Italy
2021 Division of Cardiology, University of California Los Angeles (UCLA) David Geffen School of Medicine, and Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA
7 Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
Rev. Cardiovasc. Med. 2006, 7(S1), 12-24
Published: 20 Jan 2006
The Author(s). Published by IMR Press. This is an open access article under the CC BY 4.0 license.
Abstract
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.
