Authors
Alberto Palazzuoli, Nicolas Girerd, Massimo Piepoli, Andrew P Ambrosy, Guillaume Baudry, Juan Carlos Lopez-Azor, Mateusz Guzik, Òscar Miró, Jeroen Dauw, Gracian Iwanek, Peder Myhre, Marta Cobo Marcos, Masatake Kobayashi, Jan Biegus
Published in
European heart journal. Quality of care & clinical outcomes. Oct 19, 2026. Epub Oct 19, 2026.
Abstract
Congestion remains the first cause of hospitalization in acute heart failure patients, and it is the primary goal of treatment during early phases of hospitalization. Despite its clinical relevance, a universal algorithm for quantification or characterization is lacking. Indeed, congestion has been differently evaluated across several studies in terms of timing checks and diagnostic methods. Recent analyses have highlighted the importance of differentiating between intravascular and tissue congestion. Although it is associated with haemodynamic dysfunction, extravascular congestion may occur even in the absence of overt intravascular fluid overload. Importantly, tissue congestion is not merely a reflection of intravascular volume expansion. In this framework, the interstitial space surrounding the capillary barrier and its integrity may be accounted as additive drivers for tissue congestion. In clinical practice, this distinction remains anchored in simplistic clinical assessment, and poorly evaluated. A critical review of the evidences has been performed and multimodal approaches combining ultrasonography, invasive measurements, and biomarkers have been proposed.
PMID:
42895733
Bibliographic data and abstract were imported from PubMed on 20 Oct 2026.
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