Pulmonary Congestion Assessment in Heart Failure: Traditional and New Tools

Abstract

Congestion related to cardiac pressure and/or volume overload plays a central role in the pathophysiology, presentation, and prognosis of heart failure (HF). Most HF exacerbations are related to a progressive rise in cardiac filling pressures that precipitate pulmonary congestion and symptomatic decompensation. Furthermore, persistent symptoms and signs of congestion at discharge or among outpatients are strong predictors of an adverse outcome. Pulmonary congestion is also one of the most important diagnostic and therapeutic targets in chronic heart failure. The aim of this review is to analyze the importance of clinical, instrumental, and biochemical evaluation of congestion in HF by describing old and new tools. Lung ultrasonography (LUS) is an emerging method to assess pulmonary congestion. Accordingly, we describe the additive prognostic role of chest ultrasound with respect to traditional clinical and X-ray assessment in acute and chronic HF setting.

Association between Lung Fluid Levels Estimated by Remote Dielectric Sensing Values and Invasive Hemodynamic Measurements

“…An accurate assessment of pulmonary congestion is challenging given the lack of proven techniques to quantify lung fluid levels in granular detail [ 7 ] Chest X-ray, echocardiography, and computed tomography, as well as physical examination, are generally used to assess the pulmonary congestion, though they are imprecise and prone to wide variation in clinical interpretation [ 8 ].…”

Relationship Between Body Posture and Lung Fluid Volume Assessed Using a Novel Noninvasive Remote Dielectric Sensing System

“…Accurate assessment of the severity of pulmonary congestion is essential for the management of congestive heart failure, but thus far there is no gold standard to quantify the degree of pulmonary congestion. 12 Chest X-ray and computed tomography (CT) are often used to qualify pulmonary congestion, but these modalities may not necessarily be accurate and require expertise to interpret the results. Right heart catheterization and CardioMEMS are useful for quantifying the intracardiac pressure, although the CardioMEMS is not available in Japan thus far.…”

Prediction and Analysis of Heart Failure Decompensation Events Based on Telemonitored Data and Artificial Intelligence Methods

“…Cardiac decompensation events (CDEs) may be triggered by an exacerbation of symptoms due to systemic or pulmonary congestion, leading to hypervolemia, which requires immediate treatment. This often results in hospitalizations [ 4 ], putting a high burden on the healthcare system, families, and caregivers. Additionally, rehospitalization rates after discharge are relatively high compared to those of other age-related diseases.…”