Grigore Mihai, Nicolae Camelia, Grigore Andreea-Maria, Balahura Ana-Maria, Păun Nicolae, Uscoiu Gabriela, Verde Ioana, Ilieșiu Adriana-Mihaela
Cardio-Thoracic Department, Carol Davila University of Medicine and Pharmacy, 021021 Bucharest, Romania.
Internal Medicine and Cardiology Department, "Prof. Th. Burghele" Clinical Hospital, 050653 Bucharest, Romania.
Diagnostics (Basel). 2025 Apr 24;15(9):1083. doi: 10.3390/diagnostics15091083.
Congestion represents a defining hallmark of heart failure (HF) leading to increased morbidity and mortality in HF patients. While it was traditionally viewed as a simple and uniform state of volume overload, contemporary understanding has emphasized its complexity, distinguishing between intravascular, interstitial, and tissue congestion. Congestion contributes to overt clinical manifestation of HF. However, subclinical congestion often goes undetected, increasing the risk of adverse outcomes. Residual congestion, in particular, remains a frequent and challenging issue, with its persistence at discharge being strongly linked to rehospitalization and poor prognosis. Clinical evaluation often fails to reliably identify the resolution of congestion, highlighting the need for supplementary diagnostic methods. Improvement in imaging modalities, including lung ultrasound, venous Doppler, and echocardiography, have significantly enhanced the detection of congestion. Moreover, biomarkers such as natriuretic peptides, bioactive adrenomedullin, soluble CD146, and carbohydrate antigen 125 offer valuable, complementary insights into fluid distribution and the severity of HF congestion. Therefore, a comprehensive, multimodal strategy that integrates clinical evaluation with imaging and biomarker data is crucial for optimizing the management of congestion in HF. Future approaches should prioritize personalized decongestive therapy, addressing both intravascular and tissue congestion, while aiming to preserve renal function and limit neurohormonal activation. Refinement of these strategies holds promise for improving long-term outcomes, reducing rehospitalizations, and enhancing overall patient prognosis.
充血是心力衰竭（HF）的一个决定性标志，会导致HF患者的发病率和死亡率增加。虽然传统上认为充血是一种简单且统一的容量超负荷状态，但当代的认识强调了其复杂性，区分了血管内、间质和组织充血。充血会导致HF的明显临床表现。然而，亚临床充血往往未被发现，增加了不良后果的风险。特别是残余充血仍然是一个常见且具有挑战性的问题，其在出院时的持续存在与再次住院和不良预后密切相关。临床评估往往无法可靠地确定充血是否消退，这凸显了需要补充诊断方法。包括肺部超声、静脉多普勒和超声心动图在内的成像方式的改进，显著提高了对充血的检测能力。此外，利钠肽、生物活性肾上腺髓质素、可溶性CD146和糖类抗原125等生物标志物为液体分布和HF充血的严重程度提供了有价值的补充见解。因此，将临床评估与成像和生物标志物数据相结合的综合多模式策略对于优化HF充血的管理至关重要。未来的方法应优先考虑个性化的消肿治疗，解决血管内和组织充血问题，同时旨在保护肾功能并限制神经激素激活。这些策略的完善有望改善长期预后、减少再次住院并提高患者的总体预后。
