Journal
EUROPEAN JOURNAL OF HEART FAILURE
Volume 24, Issue 10, Pages 1751-1766Publisher
WILEY
DOI: 10.1002/ejhf.2664
Keywords
Congestion; Acute heart failure; Biomarkers
Categories
Funding
- Ministry of Economy and Competitiveness
- Instituto Carlos III [PI20/00392]
- CIBER Cardiovascular [16/11/00420, 16/11/00403]
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Congestion is a significant symptom of heart failure and it varies in different types of heart failure. This article discusses the classification of heart failure based on congestion characteristics and the utility of circulating biomarkers for assessing and managing fluid overload. Further studies are needed to determine the effectiveness of biomarkers in addition to clinical evaluation, haemodynamics, and imaging.
Congestion is a cardinal sign of heart failure (HF). In the past, it was seen as a homogeneous epiphenomenon that identified patients with advanced HF. However, current evidence shows that congestion in HF varies in quantity and distribution. This updated view advocates for a congestive-driven classification of HF according to onset (acute vs. chronic), regional distribution (systemic vs. pulmonary), compartment of distribution (intravascular vs. extravascular), and clinical vs. subclinical. Thus, this review will focus on the utility of circulating biomarkers for assessing and managing the different fluid overload phenotypes. This discussion focused on the clinical utility of the natriuretic peptides, carbohydrate antigen 125 (also called mucin 16), bio-adrenomedullin and mid-regional pro-adrenomedullin, ST2 (also known as interleukin-1 receptor-like 1), cluster of differentiation 146, troponin, C-terminal pro-endothelin-1, and parameters of haemoconcentration. The utility of circulation biomarkers on top of clinical evaluation, haemodynamics, and imaging needs to be better determined by dedicated studies. Some multiparametric frameworks in which these tools contribute to management are proposed.
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