{"id":"93830a5ca5d2","type":"article","url":"https://hartvaat.nl/2026/05/04/congestie-bij-chronisch-hartfalen-echografie-vult-klinisch-onderzoek-aan-en-voor/","title":"Congestie bij chronisch hartfalen: echografie vult klinisch onderzoek aan en voorspelt slechte prognose","title_en":"","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","hfpef","step-hfpef"],"journal":"ESC heart failure","doi":"10.1093/eschf/xvag126","source_url":"https://doi.org/10.1093/eschf/xvag126","authors":["Ahmad Alsaeed","Htet Htet Ei Khin","Elisabetta Caiazzo","Moustafa I Morsy","Joe Cuthbert","Andrew L Clark","John G F Cleland","Pasquale Maffia","Pierpaolo Pellicori"],"significance":6,"published":"2026-07-01","source_date":"2026-05-04","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/diagnose-hartfalen-stappenplan/","https://hartvaat.nl/kennis/diagnostiek/intravasculaire-echografie-ivus-oct/"],"congress":"","summary_en":"Study in 342 patients with chronic heart failure (CHF) during routine clinic visits. Clinical congestion (elevated JVP, pulmonary congestion, or peripheral oedema) was assessed unblinded versus ultrasonographic congestion (inferior vena cava diameter, jugular vein Valsalva/rest ratio, lung B-lines). eGFR was calculated with CKD-EPI 2021. eGFR distribution: <30 in 9%, 30-44 in 18%, 45-59 in 26%, >60 in 47%. Many patients — particularly with low eGFR — had both clinical and ultrasound congestion (51%, 30%, 39%, 25% per eGFR group). Isolated ultrasound congestion was also common (19-34%); isolated clinical congestion was rarer. Congestion, especially when both methods agreed, was associated with higher NT-proBNP and greater risk of HF hospitalisation or death (aHR 2.16; 95% CI 1.25-3.75; p=0.006 vs no congestion). The role of ultrasound congestion assessment in routine HF management warrants further study.","created":"2026-07-03T10:33:08Z","updated":"2026-07-03T18:39:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie bij 342 patiënten met chronisch hartfalen (CHF) tijdens een reguliere polikliniek-controle. Klinische congestie (verhoogde JVP, pulmonale congestie of perifeer oedeem) werd ongeblindeerd vergeleken met echografische congestie (vena-cava-inferior-diameter, jugulair-vein Valsalva/rust-ratio, lung B-lines). eGFR werd berekend met CKD-EPI 2021. eGFR-verdeling: <30 bij 9%, 30-44 bij 18%, 45-59 bij 26%, >60 bij 47%. Veel patiënten — vooral met lage eGFR — hadden zowel klinische als echografische congestie (51%, 30%, 39%, 25% per eGFR-groep). Geïsoleerde echografische congestie kwam ook voor (19-34%); geïsoleerde klinische congestie was zeldzamer. Congestie, vooral wanneer beide methoden afwijkend waren, was geassocieerd met hogere NT-proBNP en groter risico op HF-opname of sterfte (aHR 2,16; 95%-BI 1,25-3,75; p=0,006 versus geen congestie). De rol van echografische congestie-evaluatie in routinematig HF-management vraagt om verder onderzoek.","abstract_original":"BACKGROUND: Cardiac and renal dysfunction often conspire to cause water and salt retention. We assessed the relation between renal function and congestion, both clinically and by ultrasound, in chronic heart failure (CHF). METHOD: At a routine clinic visit, patients with CHF were classified as clinically congested if they had a raised jugular venous pressure, pulmonary congestion, or peripheral oedema, regardless of severity, blind to a subsequent ultrasound assessment of congestion, including inferior vena cava (IVC) diameter, jugular vein diameter Valsalva/rest ratio (JVD-ratio) and lung B-lines. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI 2021 equation. RESULTS: Of 342 patients, eGFR was <30 in 9%, 30-44 in 18%, 45-59 in 26% and >60 ml/min/1.73m2 in 47%. Many patients had both clinical and ultrasound evidence of congestion, especially when eGFR was low (respectively for each eGFR group: 51%, 30%, 39%, and 25%). Isolated ultrasound congestion was also common (19%, 29%, 34%, and 26%) but isolated clinical congestion less so (11%, 11%, 4%, and 9%)..Congestion, especially when detected by both methods, was associated with higher NT-proBNP concentrations and a greater probability of heart failure (HF) hospitalisation or death (adjusted HR: 2.16, 95% CI [1.25, 3.75]; P=0.006 vs no congestion). CONCLUSION: Patients with CHF often have clinical evidence of congestion, confirmed by ultrasound, which is associated with a poor prognosis. Patients with a low eGFR are more likely to be congested. Whether ultrasound assessment of congestion can improve the management of patients with CHF requires more attention."}