Ultrasound imaging of congestion in heart failure: a narrative review.

Background and Objective: Congestion is a key determinant in the evolution of patients with heart failure (HF), leading to higher rates of emergency visits, hospital admissions and even mortality. Both clinical and subclinical congestion have been associated with a worse prognosis, hence the importance of its correct detection, characterization and treatment. Multiparametric assessment with ultrasound imaging, lung ultrasound (LUS) and venous Doppler analysis, has emerged as a very informative and accessible diagnostic tool in HF patients throughout their evolution. This review aims to provide a practical approach for the implementation of these techniques as well as a comprehensive summary of their prognostic and therapeutic applications in specific clinical settings. Methods: Relevant literature from 1997 to 2024 on congestion evaluation and management based on ultrasonographic findings was retrieved through PubMed research. Only English publications were included. Key Content and Findings: Ultrasound imaging for congestion detection and management is increasingly convening attention in HF scientific literature. Observational and randomized studies exhibit consistent and reproducible results where greater degrees of congestion have been strongly associated with worse clinical short- and long-term outcomes both in acute and chronic HF. On the other hand, ultrasound imaging helps adjusting diuretic therapy with more frequent and robust evidence regarding LUS than venous Doppler analysis. Conclusions: Despite exponential growing evidence supporting the use of ultrasound imaging in HF, LUS and venous Doppler analysis are not yet routine. Forthcoming evidence may help to consolidate these techniques in the management of HF patients.