Clinical and Subclinical Congestion in Acute Heart Failure: A Multimodal Prognostic Assessment

Area of Science:

• Cardiology
• Medical Imaging
• Clinical Research

Background:

• Congestion is a key factor in heart failure (HF) outcomes.
• Non-invasive methods for detecting subclinical congestion need further validation.
• Understanding the interplay of clinical and subclinical congestion is crucial for HF management.

Purpose of the Study:

• To evaluate the prevalence, progression, and prognostic significance of clinical and subclinical congestion markers in hospitalized HF patients.
• To assess the correlation between various congestion assessment tools.
• To determine the impact of congestion on post-discharge outcomes.

Main Methods:

• Prospective cohort study of 94 hospitalized HF patients with serial assessments.
• Clinical congestion assessed via physical examination.
• Subclinical congestion evaluated using lung ultrasound (LUS), Venous Excess Ultrasound Score (VExUS), and Remote Dielectric Sensing (ReDS).
• Primary endpoint: composite of mortality, HF readmission, or unscheduled diuretic visits within 6 months.

Main Results:

• Despite clinical improvement, 30% of patients remained clinically congested at discharge.
• Nearly half of clinically euvolemic patients had subclinical congestion.
• Pulmonary B-lines (LUS) and clinical congestion at discharge predicted adverse outcomes.
• Combined clinical and subclinical congestion correlated with lower event-free survival.

Conclusions:

• Subclinical congestion is prevalent in HF patients and linked to poorer outcomes.
• Non-invasive markers like LUS provide valuable prognostic information.
• Integrating clinical assessment with non-invasive tools can enhance post-discharge risk stratification for HF patients.