Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, 356 Sygrou Av, 176 74, Athens, Greece.
Noninvasive Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
Heart Fail Rev. 2020 Nov;25(6):927-935. doi: 10.1007/s10741-019-09863-5.
Congestion is one of the most prominent characteristics of patients presented with decompensated heart failure and it implies unfavorable prognosis for the heart failure patient. Neurohumoral and immuno-inflammatory activation secondary to cardiac dysfunction constitute the pivotal mechanisms driving the heart failure syndrome that results in progressive fluid accumulation. In addition, fluid redistribution between different vascular compartments in human body guided from sympathetic activity constitutes another mechanism for heart failure decompensation. Ultrasound applied in the form of echocardiography provides invaluable data for the assessment of intracardiac filling pressures. The type of renal venous flow can provide the degree of renal congestion and probably insight into the pathophysiology of the decompensation of heart failure. Assessment of lung congestion in the patient with heart failure can be accomplished by lung ultrasonography. Additionally, clinical studies on the role of ultrasound in the management and prognosis of the congested patient are reviewed. Special heart failure population supported with left ventricular assist devices and extracorporeal membrane oxygenation support constitute an area where ultrasound guidance of fluid management has gained important role.
充血是失代偿性心力衰竭患者最突出的特征之一，这意味着心力衰竭患者的预后不佳。心脏功能障碍引起的神经体液和免疫炎症激活构成了心力衰竭综合征的关键机制，导致进行性液体蓄积。此外，来自交感神经活动的人体不同血管腔室之间的液体再分布是心力衰竭失代偿的另一种机制。以超声心动图形式应用的超声为评估心内充盈压提供了非常有价值的数据。肾静脉血流的类型可以提供肾充血的程度，并可能深入了解心力衰竭失代偿的病理生理学。心力衰竭患者的肺充血评估可以通过肺超声完成。此外，还回顾了关于超声在充血患者管理和预后中的作用的临床研究。接受左心室辅助装置和体外膜氧合支持的心力衰竭特殊人群构成了超声引导液体管理获得重要作用的领域。
