{"id":"4e8dae120415","type":"article","url":"https://hartvaat.nl/2026/05/25/het-spectrum-van-congestie-bij-hartfalen-pathofysiologie-en-diagnostische-strate/","title":"Het spectrum van congestie bij hartfalen: pathofysiologie en diagnostische strategieën","title_en":"","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","bisoprolol","gedilateerde-cardiomyopathie","hfmref","hfpef","hfref","hypertrofische-cardiomyopathie","iaso-dcm","ijzersuppletie","laminopathie","myocardinfarct","nt-probnp","pathfinder-trial","step-hfpef","vrouwen"],"journal":"Heart failure reviews","doi":"10.1007/s10741-026-10639-x","source_url":"https://doi.org/10.1007/s10741-026-10639-x","authors":["Alberto Palazzuoli","Matteo Beltrami","Oliviana Geavlete","Gaetano Ruocco","Masatake Kobayashi","Francesca Susini","Irene Carlino","Giuseppe Schirò","Andrew P Ambrosy","Ovidiu Chioncel"],"significance":6,"published":"2026-05-31","source_date":"2026-05-25","image":"https://hartvaat.nl/global/img/5982e3e8aeca.webp","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-en-hartfalen/","https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"Review of the complex pathophysiology and diagnosis of congestion in heart failure — the principal driver of decompensation recurrence. The authors discuss the recently proposed intra- vs extravascular congestion classification and the lack of a uniform multiparametric assessment. Clinical examination alone often underestimates congestion; a multimodal approach combining ultrasonography (lung, cardiac, IVC, abdominal), invasive haemodynamics and biomarkers is recommended. Key insight: haemodynamic congestion with elevated intracardiac pressures does not always coincide with systemic fluid retention. The review presents profile-driven approaches for early congestion detection.","created":"2026-07-03T10:32:58Z","updated":"2026-07-03T18:39:34Z","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":"Overzichtsartikel over de complexe pathofysiologie en diagnose van congestie bij hartfalen, de belangrijkste drijver van recidiverende decompensatie. De auteurs bespreken de recent voorgestelde scheiding tussen intravasculaire en extravasculaire congestie en het tekort aan een uniforme multiparametrische beoordeling. Klinisch onderzoek alleen onderschat congestie vaak; multimodale benadering met echografie (long, hart, vena cava, abdominaal), invasieve hemodynamische metingen en biomarkers wordt aanbevolen. Belangrijke notie: hemodynamische congestie met verhoogde intracardiale drukken valt niet altijd samen met systemische vochtretentie. De review presenteert profiel-gestuurde benaderingen voor vroege congestiedetectie.","abstract_original":"Congestion is the main driver of heart failure (HF) recurrence and its relief remains the primary therapeutic target during acute management. In most studies achievement of decongestion is evaluated by clinical examination. The lack of accurately recognizing congestion, together with the incomplete understanding of its underlying pathophysiological mechanisms, may lead to a substantial discordance between de-congestion and mortality risk reduction. To avoid these concerns, a classification dividing congestion between intra vs. extravascular, has been recently purposed but it is still based on clinical signs rather than an integrated diagnostic assessment. Additionally, across several studies, congestion is evaluated at various time moments and with different diagnostic methods. Over the last decades new approaches combining ultrasonographic evaluation, invasive measurement and biomarkers have been suggested, although a universal multi-parametric diagnostic strategy is not extensively applied. The complex mechanisms and dynamic nature of fluid retention, venous capacitance, lymphatic conditions and interstitial space integrity are relevant components which contributes to create further misunderstanding. The numerous cardiac and extracardiac factors potentially involved in congestion onset and recurrence need to be addressed during the evaluation. In this paper we would gather potential approaches for early congestion detection according to HF profile, based on the assumption that hemodynamic congestion and increased cardiac pressure does not necessarily coincide with systemic fluid retention."}