Prognostic Role of Cardiac, Pulmonary and Systematic Congestion in Patients Hospitalized for Acute Heart Failure

Clinical congestion is the main driver of heart failure (HF) decomposition and hospitalization. The combined assessment of congestion status at admission, through clinical examination, echocardiography and lung ultrasound, should be used to better recognize the type and the site of congestion. Different congestion locations may be related to a different outcome. The study evaluated: 1) Cardiac, pulmonary and systematic congestion occurrence in heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF); 2) The prognostic role of different congestion (Cardiac vs. Pulmonary vs. Systematic in terms of cardiovascular death or re-hospitalization during 6-month of follow up). Multi-centre, Observational study was implemented, including patients with the diagnosis of acute heart failure (AHF) according to the recent HF guidelines. A total of 230 patients with AHF (135 HFrEF and 95 HFpEF) were included in the analysis. Systemic congestion was significantly prevalent In HFrEF with respect to HFpEF due to the evidence of increased ICV size (22 5 vs. 17 4 mm; p 0.05) and a lower rate of reduced IVC collapse in HFrEF compared with HFpEF (47% vs 32%; p 0.01). Congestion status was different between HFrEF and HFpEF patients. The systemic congestion was related to poorer outcomes. There is a linear trend among single, double and triple congestion sites and increased risk for adverse events. Further studies should investigate what the best decongestion strategy by serial and qualitative measurement of congestion localization in AHF is.