Evidence map›Paper›PMID 32415147›Full record

ReviewNature reviews. Cardiology2020

Congestion in heart failure: a contemporary look at physiology, diagnosis and treatment.

Eva M Boorsma, Jozine M Ter Maaten, Kevin Damman, Wilfried Dinh, Finn Gustafsson, Steven Goldsmith, Daniel Burkhoff, Faiez Zannad, James E Udelson, Adriaan A Voors

Open access · greenAbstract readReview
PubMed Publisher
In one paragraph

Review in Nature reviews. Cardiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 197 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
197citing papers in PubMed, 5 pooled it
24.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

197 citing papers in PubMed, 5 syntheses or guidelines pooled it, 326 citations in OpenAlex.

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137 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 6 institutions in 5 countries.

Eva M BoorsmaUniversity of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands.
Jozine M Ter MaatenUniversity of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands.
Kevin DammanUniversity of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands.
Wilfried DinhCenter for Clinical Medicine, University Faculty of Health, University of Witten Herdecke, Witten, Germany.
Finn GustafssonDepartment of Cardiology and Clinical Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Steven GoldsmithDepartment of Medicine, Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA.
Daniel BurkhoffDivision of Cardiology, Tufts Medical Center, Boston, MA, USA.
Faiez ZannadUniversite de Lorraine, Inserm, Centre d'Investigations Cliniques- Plurithematique 14-33, and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.ORCID http://orcid.org/0000-0001-7456-1570
James E UdelsonDivision of Cardiology, Tufts Medical Center, Boston, MA, USA.
Adriaan A VoorsUniversity of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands. a.a.voors@umcg.nl.ORCID http://orcid.org/0000-0002-5417-4415
University Medical Center Groningen · NLTufts Medical Center · USInserm · FRUniversity of Copenhagen · DKUniversity of Minnesota · USWitten/Herdecke University · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Congestion is the main reason for hospitalization in patients with acute decompensated heart failure and is an important target for therapy. However, achieving complete decongestion can be challenging. Furthermore, residual congestion before discharge from hospital is associated with a high risk of early rehospitalization and death. An improved understanding of the pathophysiology of congestion is of great importance in finding better and more personalized therapies. In this Review, we describe the two different forms of congestion - intravascular congestion and tissue congestion - and hypothesize that differentiating between and specifically treating these two different forms of congestion could improve the outcomes of patients with acute decompensated heart failure. Although the majority of these patients have a combination of both intravascular and tissue congestion, one phenotype can dominate. Each of these two forms of congestion has a different pathophysiology and requires a different diagnostic approach. We provide an overview of novel and established biomarkers, imaging modalities and mechanical techniques for identifying each type of congestion. Treatment with loop diuretics, the current cornerstone of decongestive treatment, reduces circulating blood volume and thereby reduces intravascular congestion. However, the osmolality of the circulating blood decreases with the use of loop diuretics, which might result in less immediate translocation of fluid from the tissues (lungs, abdomen and periphery) to the circulation when the plasma refill rate is exceeded. By contrast, aquaretic drugs (such as vasopressin antagonists) predominantly cause water excretion, which increases the osmolality of the circulating blood, potentially improving translocation of fluid from the tissues to the circulation and thereby relieving tissue congestion.

Indexed as

Heart FailureAlgorithmsDiagnosis, DifferentialHumans

Identifiers

PMID32415147
OpenAlexW3025231148

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.