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 1 2, Rafael de la Espriella 1 2, Patrick Rossignol 3, Adriaan A Voors 4, Wilfried Mullens 5, Marco Metra 6, Ovidiu Chioncel 7, James L Januzzi 8, Christian Mueller 9, A Mark Richards 10 11, Rudolf A de Boer 4, Thomas Thum 12 13, Henrike Arfsten 14 15, Arantxa González 2 16, Magdy Abdelhamid 17, Stamatis Adamopoulos 18, Stefan D Anker 19, Tuvia Ben Gal 20, Jan Biegus 21, Alain Cohen-Solal 22, Michael Böhm 23, Michele Emdin 24 25, Ewa A Jankowska 21, Finn Gustafsson 26, Loreena Hill 27, Tiny Jaarsma 28, Pardeep S Jhund 29, Yuri Lopatin 30, Lars H Lund 31, Davor Milicic 32, Brenda Moura 33 34, Massimo F Piepoli 35, Piotr Ponikowski 21, Amina Rakisheva 36, Arsen Ristic 37, Gianluigi Savarese 31, Carlo G Tocchetti 38, Sophie Van Linthout 15 39, Maurizio Volterrani 40, Petar Seferovic 41 42, Giuseppe Rosano 43, Andrew J S Coats 44, Antoni Bayes-Genis 2 45 46
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.
Keywords: Acute heart failure; Biomarkers; Congestion.