LAUSR

Congestion is the main cause of hospitalization for acute heart failure (HF).1,2 It can be detected by biomarkers and imaging tools for the diagnosis, prognostic evaluation and, possibly, to guide treatment, in patients with acute HF.3–7 Pellicori et al.8 reviewed ultrasound methods for the detection and quantification of congestion, including imaging of the heart, lungs (B-lines), kidneys (intrarenal venous flow) and venous system (inferior vena cava and internal jugular vein diameter). Organ injury may be a major mechanism of the deleterious effects of congestion in patients with acute HF.6 Kozhuharov et al.9 studied patients presenting to the emergency department with acute dyspnoea and showed that plasma levels of cardiac myosin-binding protein C (cMyC), a marker of myocardial injury, were higher in those with acute HF and were a marker of increased risk of all-cause mortality [hazard ratio (HR) 2.19, 95% confidence interval (CI) 1.66-2.89; P< 0.001 for patients above median cMyC concentrations]. Congestion relief has an impact on the prognostic value of markers of kidney function.6 In a prospective, single-centre study, 215 patients with acute HF were divided into four profiles based on their estimated glomerular filtration rate (eGFR) (preserved vs. impaired) and spot urine sodium (sodium excreter vs. non-excreter). Both sodium non-excreter profiles were associated with an increased risk of in-hospital worsening HF, use of inotropes and readmissions due to acute HF. The preserved eGFR/non-excreter profile had the highest 1-year mortality and was an independent predictor of poor outcome at multivariable aanalysis.10