Congestion in heart failure: a circulating biomarker-based perspective. A review from the Biomarkers Working Group of the Heart Failure Association, European Society of Cardiology

Julio Núñez, Rafael de la Espriella, Patrick Rossignol, Adriaan A. Voors, Wilfried Mullens, Marco Metra, Ovidiu Chioncel, James L. Januzzi, Christian Mueller, A. Mark Richards, Rudolf A. de Boer, Thomas Thum, Henrike Arfsten, Arantxa González, Magdy Abdelhamid, Stamatis Adamopoulos, Stefan D. Anker, Tuvia Ben Gal, Jan Biegus, Alain Cohen-SolalMichael Böhm, Michele Emdin, Ewa A. Jankowska, Finn Gustafsson, Loreena Hill, Tiny Jaarsma, Pardeep S. Jhund, Yuri Lopatin, Lars H. Lund, Davor Milicic, Brenda Moura, Massimo F. Piepoli, Piotr Ponikowski, Amina Rakisheva, Arsen Ristic, Gianluigi Savarese, Carlo G. Tocchetti, Sophie Van Linthout, Maurizio Volterrani, Petar Seferovic, Giuseppe Rosano, Andrew J.S. Coats, Antoni Bayes-Genis*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Congestion is a cardinal sign of heart failure (HF). In the past, it was seen as a homogeneous epiphenomenon that identified patients with advanced HF. However, current evidence shows that congestion in HF varies in quantity and distribution. This updated view advocates for a congestive-driven classification of HF according to onset (acute vs. chronic), regional distribution (systemic vs. pulmonary), compartment of distribution (intravascular vs. extravascular), and clinical vs. subclinical. Thus, this review will focus on the utility of circulating biomarkers for assessing and managing the different fluid overload phenotypes. This discussion focused on the clinical utility of the natriuretic peptides, carbohydrate antigen 125 (also called mucin 16), bio-adrenomedullin and mid-regional pro-adrenomedullin, ST2 (also known as interleukin-1 receptor-like 1), cluster of differentiation 146, troponin, C-terminal pro-endothelin-1, and parameters of haemoconcentration. The utility of circulation biomarkers on top of clinical evaluation, haemodynamics, and imaging needs to be better determined by dedicated studies. Some multiparametric frameworks in which these tools contribute to management are proposed.

Original languageEnglish
Pages (from-to)1751-1766
JournalEuropean Journal of Heart Failure
Volume24
Issue number10
Early online date07 Sept 2022
DOIs
Publication statusPublished - 01 Oct 2022

Keywords

  • Acute heart failure
  • Congestion
  • Biomarkers

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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