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Randomized Controlled Trial
. 2025 Oct;12(5):3741-3749.
doi: 10.1002/ehf2.15380. Epub 2025 Jul 30.

The role of intra-abdominal pressure and point of care ultrasound to guide decongestive therapies in acute heart failure

C Josa-Laorden  1 , A Campos-Saenz de Santamaría  2   3 , S Crespo-Aznarez  2   3 , J Pérez-Silvestre  4 , E Montero-Hernandez  5 , P Llacer-Iborra  6 , J Torres-Macho  7 , M Méndez-Bailon  8 , J L Morales-Rull  9 , P Salamanca-Bautista  10 , N Fernández-Villa  11 , I Torres-Courchoud  12 , M A Vázquez-Ronda  13 , R Martínez-Gutiérrez  14 , P Serrano-Irigoyen  3 , N García-Lorente  3 , J C Trullas  15 , M Cobo-Marcos  16 , M J Pinilla  17 , M Sánchez-Marteles  2   3 , J Rubio-Gracia  2   3
Affiliations
Randomized Controlled Trial

The role of intra-abdominal pressure and point of care ultrasound to guide decongestive therapies in acute heart failure

C Josa-Laorden et al. ESC Heart Fail. 2025 Oct.

Abstract

Aims: Effective decongestion is crucial in managing acute decompensated heart failure (ADHF). Persistent congestion post-diuretic therapy correlates with adverse outcomes. This study evaluates whether a strategy guided by intra-abdominal pressure (IAP) and point-of-care ultrasound (POCUS) enhances decongestion compared to standard diuretic titration.

Methods and results: ABDOPOCUS-HF is a randomized, multicentre, open-label, pragmatic clinical trial involving 168 patients hospitalized with ADHF across 14 Spanish hospitals. Inclusion criteria encompass clinical signs of congestion and elevated natriuretic peptides (NT-proBNP >1000 pg/mL or BNP > 250 pg/mL). Participants are randomized 1:1 to either standard care or an intervention arm where diuretic therapy is guided by baseline IAP measurements and POCUS assessments, including lung ultrasound, inferior vena cava diameter and VExUS score. The primary endpoint is the resolution of systemic congestion at 72 h, measured by the ADVOR score. Secondary endpoints include changes in pulmonary congestion (B-lines), intravascular congestion (VExUS and IVC), biomarkers (NT-proBNP and CA125), total diuretic dose, diuretic response, hospital length of stay and rates of cardiovascular death, rehospitalization and need for intravenous diuretics at 30 and 90 days. Safety endpoints encompass worsening renal function, electrolyte disturbances and catheter-related infections.

Conclusions: The ABDOPOCUS-HF trial investigates whether integrating IAP and POCUS into decongestion strategies improves diuretic response and clinical outcomes in ADHF patients. Findings may inform future protocols for volume management in acute heart failure.

Keywords: Acute heart failure; Cardio‐renal syndrome; Diuretics; Intra‐abdominal pressure; Point of care ultrasound.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Protocol and outcomes. IAP, intra‐abdominal pressure; i.v., intravenous; ivc, inferior vena cava; LUS, lung ultrasound; POCUS, point of care ultrasound; VeXuS, venous excess ultrasound protocol.
Figure 2
Figure 2
Diuretic protocol. eGFR, estimated glomerular filtration rate; IAP, intra‐abdominal pressure; iv, intravenous; IVC, inferior vena cava.
Figure 3
Figure 3
Schedule of study procedures. IAP, intra‐abdominal pressure; POCUS, point of care ultrasound.
See this image and copyright information in PMC

References

    1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2023 focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2023;44:3627–3639. doi: 10.1093/eurheartj/ehad195 - DOI - PubMed
    1. Rubio‐Gracia J, Demissei BG, Ter Maaten JM, Cleland JG, O'Connor ChM, Metra M, et al. Prevalence, predictors and clinical outcomes of residual congestion in acute decompensated heart failure. Int J Cardiol 2018;258:185–191. doi: 10.1016/j.ijcard.2018.01.067 - DOI - PubMed
    1. Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med 2011;364:797–805. doi: 10.1056/NEJMoa1005419 - DOI - PMC - PubMed
    1. Núñez J, Llácer P, García‐Blas S, Bonanad C, Ventura S, Núñez JM, et al. CA125‐guided diuretic treatment versus usual care in patients with acute heart failure and renal dysfunction. Am J Med 2020;133:370–380. doi: 10.1016/j.amjmed.2019.07.041 - DOI - PubMed
    1. Biegus J, Zymlinski R, Sokolski M, Todd J, Cotter G, Metra M, et al. Serial assessment of spot urine sodium predicts effectiveness of decongestion and outcome in patients with acute heart failure. Eur J Heart Fail 2019;2:624–633. - PubMed

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