Methods for the Assessment of Volume Overload and Congestion in Heart Failure

Abstract

Acute decompensated heart failure entails a dysregulation of renal and cardiac function, with fluid volume excess or congestion being a key component. We provide an overview of methods for its assessment in clinical practice. Evaluation of congestion can be achieved using different methods including plasma biomarkers, measurement of blood volume from the volume of distribution of [131I]-human serum albumin, sonographic modalities, implantable devices, invasive measurements of volume status including right heart catheterization, and impedance methods. Integration into clinical practice of accessible, cost-effective, and evidence-based modalities for volume assessment will be pivotal in the management of acute decompensated heart failure.

Trial registration: ClinicalTrials.gov NCT04089059.

Figure 1

Methods for assessment of pulmonary and hemodynamic congestion in patients with HF. Alb, albumin; BVA, blood volume analysis; Hb, hemoglobin; Hct, hematocrit; HF, heart failure; ICG, impedance cardiography; NT-pro BNP, N-terminal pro-brain natriuretic peptide.

Figure 2

Ultrasound images. (A) Normal lung showing horizontal artifacts (A-line represented by arrows. (B) Vertical artifacts typically seen in congestion (B-line represented by arrows). (C) Pleural effusion indicated by asterisk. (D) IVC. IVC, inferior vena cava. Images used with permission.

Figure 3

VExUS ultrasound depicting the relations between hepatic vein Doppler systolic (S) wave and diastolic (D) wave indicate varying degrees of congestion. Portal vein Doppler pulsatility similarly correlates with increasing congestion. Renal vein Doppler indicates increasing congestion when pulsatility becomes present in S and D waveforms. VExUS, venous excess ultrasound. Figure adapted from NephroPOCUS.com with permission.