Mínguez Silvia, Civera José, de la Espriella Rafael, Iraola Diego, Núñez Julio
Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Avda. Blasco Ibáñez 17, Valencia 46010, Spain.
Department of Medicine, Universitat de València, Avda. Blasco Ibáñez 13, Valencia 46010, Spain.
Eur Heart J Case Rep. 2025 Jul 23;9(8):ytaf343. doi: 10.1093/ehjcr/ytaf343. eCollection 2025 Aug.
Worsening heart failure (WHF) may occasionally present with predominant extravascular fluid overload without clear intravascular congestion. This scenario can challenge traditional diuretic-based strategies, particularly in patients with infiltrative cardiomyopathies such as amyloid light-chain (AL) amyloidosis, where congestion often manifests as volume overload without substantial intravascular volume expansion.
This case report highlights the potential efficacy of venous leg compression (VLC)-a therapeutic approach traditionally employed in chronic venous diseases to improve venous return-combined with parenteral diuretic therapy in alleviating signs and symptoms in a 50-year-old woman with AL amyloidosis and WHF. In this patient, VLC was associated with tissue decongestion, enhanced vascular refill, and clinical improvement, suggesting its role in optimizing the diuretic response despite the absence of intravascular congestion.
Venous leg compression emerges as a promising adjunctive therapy for managing WHF with predominant extravascular fluid overload, especially when conventional diuretics may be limited by the lack of intravascular congestion. These findings support the potential utility of VLC as a complementary strategy in this subset of patients. Further studies are warranted to establish its safety and efficacy.
心力衰竭恶化（WHF）偶尔可能主要表现为血管外液体超负荷，而无明显的血管内充血。这种情况可能会挑战传统的基于利尿剂的治疗策略，尤其是在浸润性心肌病患者中，如轻链（AL）淀粉样变性，其中充血常表现为容量超负荷，而无明显的血管内容量扩张。
本病例报告强调了腿部静脉压迫（VLC）——一种传统上用于慢性静脉疾病以改善静脉回流的治疗方法——与肠外利尿剂治疗相结合，在缓解一名50岁AL淀粉样变性和WHF女性的体征和症状方面的潜在疗效。在该患者中，VLC与组织消肿、血管再充盈增强及临床改善相关，提示其在优化利尿剂反应中的作用，尽管不存在血管内充血。
腿部静脉压迫成为治疗以血管外液体超负荷为主的WHF的一种有前景的辅助治疗方法，尤其是当传统利尿剂可能因缺乏血管内充血而受到限制时。这些发现支持VLC作为这部分患者补充策略的潜在效用。有必要进行进一步研究以确定其安全性和疗效。
