What question did this study set out to answer?

Determine whether adding bilateral lower-limb compression bandaging to standard parenteral loop-diuretic therapy improves natriuresis, weight loss, and decongestion in acute decompensated heart failure with predominant tissue congestion.

August 14, 2026ESC Heart FailureOpen Access

Lower-limb compression in AHF and predominant tissue congestion: rationale and design of the COMPRESSION-HF trial

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Acute decompensated heart failure (ADHF) (n=106). Intervention: Active bilateral lower-limb compression plus parenteral furosemide vs. Sham bandaging plus parenteral furosemide. Primary outcome: 24-h urinary sodium excretion and change in body weight from baseline.

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Why the study?

In ADHF with predominant interstitial fluid expansion but without intravascular overload, intensifying diuretics may cause intravascular depletion and renal worsening without clearing excess tissue fluid.

Does active bilateral lower-limb compression added to parenteral furosemide improve 24-h urinary sodium excretion and weight loss in adults with ADHF and predominant peripheral oedema?

Population

106 adults with ADHF, bilateral leg oedema, NT-proBNP >1000 pg/mL, and IVC diameter ≤21 mm

Comparison

Active bilateral lower-limb compression plus parenteral furosemide vs sham bandaging plus parenteral furosemide

Design

Investigator-initiated multicentre randomized double-blind sham-controlled trial

Follow-up

Up to 72 h (30-day safety)

Key result

The COMPRESSION-HF trial randomized 106 patients to test if lower-limb compression improves decongestion, powered to detect a 20 mmol difference in 24-h urinary sodium excretion versus sham.

Authors

JCJosé Civera ECElena Chover PCPatricia Castro

Discussion

Member takes

Overview

May warrant caution with diuretic escalation in ADHF with isolated interstitial overload; challenges standard practice and supports phenotype-specific trials.

Key Points

Determine whether adding bilateral lower-limb compression bandaging to standard parenteral loop-diuretic therapy improves natriuresis, weight loss, and decongestion in acute decompensated heart failure with predominant tissue congestion.
Multicentre, randomised, double-blind, sham-controlled trial (NCT06418932) allocating 106 adults with ADHF, leg oedema (≥grade II/IV), NT-proBNP >1000 pg/mL, and IVC diameter ≤21 mm 1:1 to active two-layer compression (~20 mmHg) or sham bandaging plus furosemide for up to 72 hours.
Evaluated co-primary endpoints of 24-hour urinary sodium excretion and body weight change from baseline using mixed-effects ANCOVA and repeated-measures models.
Enrollment is complete with 106 patients randomised, providing statistical power to detect a 20 mmol between-group difference in 24-hour urinary sodium excretion.
Trial design focuses on establishing whether mechanical compression promotes intravascular refilling from congested tissues to augment diuretic response without causing intravascular volume depletion.

Study Design

Type

RCT (n=106)

Blinding

Double-blind

Randomization

1:1

Multicenter

Yes

Structured PICO

Does active bilateral lower-limb compression added to parenteral furosemide improve 24-h urinary sodium excretion and weight loss in adults with ADHF and predominant peripheral oedema?

Population

106 adults with acute decompensated heart failure, bilateral leg edema, and IVC diameter ≤21 mm, randomized to active lower-limb compression or sham for up to 72 hours.

Intervention

Active bilateral lower-limb compression (two-layer inelastic-elastic bandaging; nominal ankle pressure approximately 20 mmHg) plus parenteral furosemide for up to 72 hours

Comparator

Sham bandaging plus parenteral furosemide for up to 72 hours

Outcome

24-h urinary sodium excretion and change in body weight from baselinesurrogate

The COMPRESSION-HF trial will determine if adding lower-limb compression to parenteral furosemide improves early decongestion in ADHF patients with predominant tissue congestion.

Cite This Study

Civera et al. (2026) conducted an RCT in Acute decompensated heart failure (ADHF) (n=106). Active bilateral lower-limb compression plus parenteral furosemide vs. Sham bandaging plus parenteral furosemide was evaluated on 24-h urinary sodium excretion and change in body weight from baseline. The COMPRESSION-HF trial randomized 106 patients to test if lower-limb compression improves decongestion, powered to detect a 20 mmol difference in 24-h urinary sodium excretion versus sham.

synapsesocial.com/papers/6a7ec79cb70b84ec8b9140a6 https://doi.org/10.1093/eschf/xvag214

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August 14, 2026ESC Heart FailureOpen Access

Lower-limb compression in AHF and predominant tissue congestion: rationale and design of the COMPRESSION-HF trial

View Full Paper

Ask AI

Bookmark

Why the study?

Does active bilateral lower-limb compression added to parenteral furosemide improve 24-h urinary sodium excretion and weight loss in adults with ADHF and predominant peripheral oedema?

Population

106 adults with ADHF, bilateral leg oedema, NT-proBNP >1000 pg/mL, and IVC diameter ≤21 mm

Comparison

Active bilateral lower-limb compression plus parenteral furosemide vs sham bandaging plus parenteral furosemide

Design

Investigator-initiated multicentre randomized double-blind sham-controlled trial

Follow-up

Up to 72 h (30-day safety)

Key result

The COMPRESSION-HF trial randomized 106 patients to test if lower-limb compression improves decongestion, powered to detect a 20 mmol difference in 24-h urinary sodium excretion versus sham.

Authors

JCJosé Civera ECElena Chover PCPatricia Castro

Discussion

Member takes

Overview

May warrant caution with diuretic escalation in ADHF with isolated interstitial overload; challenges standard practice and supports phenotype-specific trials.

Key Points

Determine whether adding bilateral lower-limb compression bandaging to standard parenteral loop-diuretic therapy improves natriuresis, weight loss, and decongestion in acute decompensated heart failure with predominant tissue congestion.
Multicentre, randomised, double-blind, sham-controlled trial (NCT06418932) allocating 106 adults with ADHF, leg oedema (≥grade II/IV), NT-proBNP >1000 pg/mL, and IVC diameter ≤21 mm 1:1 to active two-layer compression (~20 mmHg) or sham bandaging plus furosemide for up to 72 hours.
Evaluated co-primary endpoints of 24-hour urinary sodium excretion and body weight change from baseline using mixed-effects ANCOVA and repeated-measures models.
Enrollment is complete with 106 patients randomised, providing statistical power to detect a 20 mmol between-group difference in 24-hour urinary sodium excretion.
Trial design focuses on establishing whether mechanical compression promotes intravascular refilling from congested tissues to augment diuretic response without causing intravascular volume depletion.

Study Design

Type

RCT (n=106)

Blinding

Double-blind

Randomization

1:1

Multicenter

Yes

Structured PICO

Does active bilateral lower-limb compression added to parenteral furosemide improve 24-h urinary sodium excretion and weight loss in adults with ADHF and predominant peripheral oedema?

Population

106 adults with acute decompensated heart failure, bilateral leg edema, and IVC diameter ≤21 mm, randomized to active lower-limb compression or sham for up to 72 hours.

Intervention

Active bilateral lower-limb compression (two-layer inelastic-elastic bandaging; nominal ankle pressure approximately 20 mmHg) plus parenteral furosemide for up to 72 hours

Comparator

Sham bandaging plus parenteral furosemide for up to 72 hours

Outcome

24-h urinary sodium excretion and change in body weight from baselinesurrogate

The COMPRESSION-HF trial will determine if adding lower-limb compression to parenteral furosemide improves early decongestion in ADHF patients with predominant tissue congestion.

Cite This Study

synapsesocial.com/papers/6a7ec79cb70b84ec8b9140a6 https://doi.org/10.1093/eschf/xvag214

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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