Persistent Congestion Research Articles

Suero salino hipertónico e insuficiencia cardiaca: ¿«sodio-centrista» o «cloro-centrista»?

Up to 50% of patients admitted for heart failure have congestion at discharge despite diagnostic and therapeutic advances. Both persistent congestion and diuretic resistance are associated with worse prognosis. The combination of hypertonic saline and loop diuretic has shown promising results in different studies. However, it has not yet achieved a standardized use, partly because of the great heterogeneity in the concentration of sodium chloride, the dose of diuretic or the amount of sodium in the diet. Classically, the movement of water from the intracellular space due to an increase in extracellular osmolarity has been postulated as the main mechanism involved. However, chloride deficit is postulated as the main up-regulator of plasma volume changes, and its correction may be the main mechanism involved. This ‘chloride centric’ approach to heart failure opens the door to therapeutic strategies that would include diuretics to correct hypochloremia, as well as sodium free chloride supplementation.

Renal venous Doppler ultrasound – a new parameter for predicting outcomes in patients with decompensated heart failure

Aim. To assess the frequency, dynamics, and prognostic value of renal venous congestion using Doppler ultrasound in patients with decompensated heart failure (DHF).Materials and methods. A prospective, single-center study included 124 patients with DHF (mean age 70 ± 12 years, 51.6% were males), left ventricular ejection fraction (LVEF) 44 [34; 55] %, N-terminal pro B-type natriuretic peptide (NT-proBNP) 1,609 [591; 2,700] pg / ml. All patients underwent a standard physical examination and laboratory and instrumental tests, including the assessment of the NT-proBNP level. Renal venous blood flow was assessed using pulsed-wave Doppler ultrasound. The presence of continuous renal blood flow was considered as the absence of venous congestion, while intermittent blood flow (two-phase and single-phase flow) indicated venous congestion. Rehospitalization for DHF and reaching a composite endpoint (rehospitalization for DHF and cardiovascular mortality) within 12 months after discharge were selected as endpoints.Results. At admission, continuous renal venous blood flow was observed in 34 (27.4%) patients, intermittent renal venous blood flow was found in 90 (72.6%) patients: two-phase flow in 62 (50%) and single-phase flow in 28 (22.6%) patients with DHF. At discharge, 66 (53.2%) patients had intermittent renal venous blood flow: two-phase flow in 50 (40.3%) and single-phase flow in 16 (12.9%) patients. Correlations of renal venous congestion with the levels of NT-proBNP, serum iron, uric acid, creatinine, LVEF, systolic pressure in the pulmonary artery (SPPA), and the development of acute kidney injury (AKI) were revealed. Persistent renal venous congestion at discharge was significantly associated with a higher probability of rehospitalization for DHF (hazard ratio (HR) 1.93 95% confidence interval (CI) (1.017–3.67); p = 0.044) and a composite endpoint (HR 2.66, 95% CI (1.43–4.96); p = 0.002).Conclusion. In patients with DHF, it is necessary to evaluate renal venous blood flow using pulsed-wave Doppler ultrasound to stratify patients with development of cardiovascular complications within 12 months.

Intrarenal Venous Doppler as a novel marker for optimal decongestion, management and prognosis in acute heart failure patients.

An increase in right atrial pressure is a common feature of acute decompensated heart failure (ADHF). Such increased pressure leads to persistent kidney congestion. A marker to guide optimal diuretic therapy is missing. We aim to correlate intrarenal Doppler ultrasound (IRD) in ADHF patients with clinical outcomes to assess whether renal hemodynamic parameter changes are useful for monitoring kidney congestion. Between December 2018 and January 2020, ADHF patients requiring intravenous diuretic therapy for at least 48 hours were considered for study selection. IRD blinded examination was performed day on 1, 3, 5 and clinical and laboratory parameters were recorded. Venous Doppler profile (VDP) were classified as continuous (C), pulsatile (P), biphasic (B), or monophasic (M) according to congestion degree; B and M profiles were considered deranged. VDP improvement (VDPimp) was defined as a change of ≥ 1 pattern degree or maintenance of C or P patterns. Arterial resistive index (RI) > 0.8 was considered elevated. Outcomes of death and rehospitalization were gathered at 60 days. Data were assessed by regression and Kaplain Meier analyses. All 177 ADHF patients admitted were screened and 72 were enrolled (27 females - median age 81 [76-87] years - median EF 40% [30-52]). VDP derangement decreased from 79.2% on day 1 to 51.4% on day 5 (p < 0.05). RI elevation decreased from 60.6% on day 1 to 43.1% on day 5 (p < 0.05). At day 5, VDPimp was registered in over half of the patients (59.7%). At day 5, signs of congestion (dyspnea/edema/rales), fluid accumulation (pleural/peritoneal fluid), hematocrit, and BNP improved (p > 0.05).After 60 days, 12 (16.7%) patients were readmitted and 9 (12.5%) died. VDPimp was identified as the unique independent factor associated with readmission (OR 0.22 CI 95% 0.05-0.94, p = 0.04) and death (OR 0.07, CI 95% 0.01-0.68, p = 0.02), with significantly better outcomes identified in VDPimp patients (Log Rank test p < 0.05). Decongestion may be associated with improvements in many clinical and instrumental parameters, but only VDPimp was associated with better clinical outcome. VDPimp should be incorporated in ad hoc AHF clinical trials to better define its role in everyday practice.

ANALISIS EFEKTIFITAS SIMPANG U-TURN PADA JL. LETJEN SUPRAPTO MENGGUNAKAN METODE MANUAL KAPASITAS JALAN INDONESIA 1997 (STUDI KASUS U-TURN SP PLAZA BATAM)

U-Turns are employed as a particular access for drivers who want to switch lanes while they're moving. However, the problem that often occurs is that this intersection can be the main cause of congestion on a road. In the case of the U-Turn intersection of Arterial Road Jl. Letjen Suprapto, to be exact, is across from SP Plaza Batu Aji. Traffic jams are often caused by this, especially in the afternoon during work hours. in accordance with the 1997 Indonesian Highway Capacity Manual, This study tries to evaluate the intersection's performance and determine whether it is the primary cause of persistent traffic congestion. The technique used to obtain data is observation and documenting. The results showed that the road capacity value was 2884.1 pcu/hour. Traffic volume value in the direction of Muka Kuning - Tg. Uncang of 1458.7 pcu/hour. 2475.4 pcu/hour in the opposite direction. 1033 vehicles were shown at 17:30-18:00 as making U-turns with an average travel time of 08'36". As a result of vehicles making u-turns, delays occur which hinder the passage of vehicles through the road segment resulting in congestion. This is the main cause of congestion on this road section with a road service value of 0.51 or a service level of C. These results indicate that the road segment is still stable, but vehicle speed is starting to be controlled. The research's conclusions can act as a guide for further investigation.

B-Lines Value on Lung Ultrasound and EVEREST Score Pre-Discharge as A Predictor of Rehospitalization and Total Mortality Post Hospitalization Due to Acute Heart Failure

Background: The high rate of rehospitalization in the vulnerable phase after treatment for acute heart failure (AHF) is caused by persistent hemodynamic congestion, even though the patient has experienced clinical improvement before being discharged. The B-lines value on Lung Ultrasound is a hemodynamic parameter that has the potential to determine the post-treatment prognosis of patients with AHF, while the EVEREST score is a marker of congestion which consists of several parameters used to assess congestion clinically. Methods: Patients treated for AHF with varying ejection fraction (EF) were included in this prospective cohort study. Data on demographics, comorbidities, pre-discharge therapy and pre-discharge echocardiographic parameters were collected. The pre-discharge B-lines value and EVEREST score were calculated a maximum of 24 hours before the patient was discharged. The outcomes studied were rehospitalization and total mortality within 60 days. Results: A total of 66 samples with various EF were included until the end of the study (15 HFpEF, 8 HFmrEF, and 43 HFrEF, mean age 57.14 ± 14.68 years). During the 60-day follow-up period, 19 samples (28.9%) experienced rehospitalization and total mortality. Both the B-lines value (AUC 0.716; 95%CI 0.581-0.851; p&lt;0.006) and the EVEREST score (AUC 0.675; 95%CI 0.542-0.807%; p&lt;0.027) served as predictors of rehospitalization and total mortality. The regression model showed that the pre-discharge B-lines score was ≥9 (adjusted HR 4.865; 95%CI 1.749-13.534; p=0.002) and the pre-discharge EVEREST score ≥2 (adjusted HR 3.694; 95%CI 1.211-11.262; p=0.022) played an independent role as a predictor of rehospitalization and total mortality, regardless of BMI, diabetes mellitus, renal impairment or TAPSE. Conclusion: The pre-discharge B-line value and EVEREST score can be applied to stratify the risk of rehospitalization and total mortality after treatment for patients with AHF.

Dynamic Invasive Hemodynamic Congestion Profile Impacts Acute Myocardial Infarction Complicated by Cardiogenic Shock Outcomes: A Real-World Single-Center Study

Cardiogenic shock (CS) commonly complicates the management of acute myocardial infarction (AMI), and it results in high mortality rates. Pulmonary artery catheter (PAC) monitoring can be valuable for personalizing critical-care interventions. We hypothesized that patients with AMI-CS experiencing persistent congestion measures during the first 24 hours of the PAC installment would exhibit worse in-hospital survival rates. We studied 295 patients with AMI-CS between January 2006 and December 2021. The first 24-hour PAC-derived hemodynamic measures were divided by the congestion profiling and the proposed 2022 Cardiovascular Angiography and Interventions (SCAI) classification. Biventricular congestion was the most common profile and was associated with the highest patient mortality rates at all time points (mean 56.6%). A persistent congestive profile was associated with increased mortality rates (hazard ratio [HR] = 1.85; P = 0.002) compared with patients who achieved decongestive profiles. Patients with SCAI stages D/E had higher levels of right atrial pressure (RAP): 14-15 mmHg) and pulmonary capillary wedge pressure (PCWP): 18-20 mmHg) compared with stage C (RAP, 10-11 mmHg, mean difference 3-5 mmHg; P < 0.001; PCWP 14-17 mmHg; mean difference 1.56-4 mmHg; P = 0.011). In SCAI stages D/E, the pulmonary artery pulsatility index (0.8-1.19) was lower than in those with grade C (1.29-1.63; mean difference 0.21-0.73; P < 0.001). Continuous congestion profiling using the SCAI classification matched the grade of hemodynamic severity and the increased risk of in-hospital death. Early decongestion appears to be an important prognostic and therapeutic goal in patients with AMI-CS and warrants further study.

Design and rationale of the inferior vena CAVA and Lung UltraSound-guided therapy in Acute Heart Failure (CAVAL US-AHF Study): a randomised controlled trial

BackgroundBetween 25% and 30% of patients hospitalised for acute heart failure (AHF) are readmitted within 90 days after discharge, mostly due to persistent congestion on discharge. However, as the optimal...

The interstitial compartment as a therapeutic target in heart failure.

Congestion is the single most important contributor to heart failure (HF) decompensation. Most of the excess volume in patients with HF resides in the interstitial compartment. Inadequate decongestion implies persistent interstitial congestion and is associated with worse outcomes. Therefore, effective interstitial decongestion represents an unmet need to improve quality of life and reduce clinical events. The key processes that underlie incomplete interstitial decongestion are often ignored. In this review, we provide a summary of the pathophysiology of the interstitial compartment in HF and the factors governing the movement of fluids between the interstitial and vascular compartments. Disruption of the extracellular matrix compaction occurs with edema, such that the interstitium becomes highly compliant, and large changes in volume marginally increase interstitial pressure and allow progressive capillary filtration into the interstitium. Augmentation of lymph flow is required to prevent interstitial edema, and the lymphatic system can increase fluid removal by at least 10-fold. In HF, lymphatic remodeling can become insufficient or maladaptive such that the capacity of the lymphatic system to remove fluid from the interstitium is exceeded. Increased central venous pressure at the site of the thoracic duct outlet also impairs lymphatic drainage. Owing to the kinetics of extracellular fluid, microvascular absorption tends to be transient (as determined by the revised Starling equation). Therefore, effective interstitial decongestion with adequate transcapillary plasma refill requires a substantial reduction in plasma volume and capillary pressure that are prolonged and sustained, which is not always achieved in clinical practice. The critical importance of the interstitium in the congestive state underscores the need to directly decongest the interstitial compartment without relying on the lowering of intracapillary pressure with diuretics. This unmet need may be addressed by novel device therapies in the near future.

Prognosis value of Forrester's classification in advanced heart failure patients awaiting heart transplantation.

The value of Forrester's perfusion/congestion profiles assessed by invasive catheter evaluation in non-inotrope advanced heart failure patients listed for heart transplant (HT) is unclear. We aimed to assess the value of haemodynamic evaluation according to Forrester's profiles to predict events on the HT waitlist. All non-inotrope patients (n=837, 79% ambulatory at listing) registered on the French national HT waiting list between 1 January 2013 and 31 December 2019 with right heart catheterization (RHC) were included. The primary outcome was a combined criteria of waitlist death, delisting for aggravation, urgent HT or left ventricular assist device implantation. Secondary outcome was waitlist death. The 'warm-dry', 'cold-dry', 'warm-wet', and 'cold-wet' profiles represented 27%, 18%, 27%, and 28% of patients, respectively. At 12months, the respective rates of primary outcome were 15%, 17%, 25%, and 29% (P=0.008). Taking the 'warm-dry' category as reference, a significant increase in the risk of primary outcome was observed only in the 'wet' categories, irrespectively of 'warm/cold' status: hazard ratios, 1.50; 1.06-2.13; P=0.024 in 'warm-wet' and 1.77; 1. 25-2.49; P=0.001 in 'cold-wet'. Haemodynamic assessment of advanced HF patients using perfusion/congestion profiles predicts the risk of the combine endpoint of waitlist death, delisting for aggravation, urgent heart transplantation, or left ventricular assist device implantation. 'Wet' patients had the worst prognosis, independently of perfusion status, thus placing special emphasis on the cardinal prominence of persistent congestion in advanced HF.

Neonatal ventricular assist device implantation for high-risk hypoplastic left heart syndrome: How we do it.

Neonatal ventricular assist device implantation for high-risk hypoplastic left heart syndrome: How we do it.

Характеристика венозного застоя по шкале VExUS у пациентов с декомпенсацией хронической сердечной недостаточностью

Persistent venous congestion in patients with decompensated heart failure (DCHF) increases the risk of rehospitalization and death. VExUS protocol that evaluates the systemic hepatic-renal congestion in addition to assessing the inferior vena cava is regarded as a promising non-invasive ultrasound method to assess venous congestion in these patients.

Persistent vascular congestion in male spontaneously hypertensive rats contributes to delayed recovery of renal function following renal ischemia perfusion compared with females.

Acute kidney injury (AKI) due to ischemia is a serious and frequent clinical complication with mortality rates as high as 80%. Vascular congestion in the renal outer medulla occurs early after ischemia reperfusion (IR) injury, and congestion has been linked to worsened outcomes following IR. There is evidence implicating both male sex and preexisting hypertension as risk factors for poor outcomes following IR. The present study tested the hypothesis that male spontaneously hypertensive rats (SHR) have greater vascular congestion and impaired renal recovery following renal IR vs. female SHR and normotensive male Sprague-Dawley rats (SD). Thirteen-week-old male and female SHR and SD were subjected to sham surgery or 30 min of warm bilateral ischemia followed by reperfusion. Rats were euthanized 24 h or 7 days post-IR. IR increased renal injury in all groups vs. sham controls at 24 h. At 7 days post-IR, injury remained elevated only in male SHR. Histological examination of SD and SHR kidneys 24 h post-IR showed vascular congestion in males and females. Vascular congestion was sustained only in male SHR 7 days post-IR. To assess the role of vascular congestion on impaired recovery following IR, additional male and female SHR were pretreated with heparin (200 U/kg) prior to IR. Heparin pretreatment reduced IR-induced vascular congestion and improved renal function in male SHR 7 days post-IR. Interestingly, preventing increases in blood pressure (BP) in male SHR did not alter sustained vascular congestion. Our data demonstrate that IR-induced vascular congestion is a major driving factor for impaired renal recovery in male SHR.

Monitoring decongestion in acute heart failure

Persistent congestion following an episode of acute heart failure is associated with higher morbidity and mortality. Monitoring diuretic therapy is essential to guide effective decongestion before patient discharge. Unfortunately, there are no markers which can predict on their own, the exact point in which euvolemia is achieved. Cardiothoracic and extra thoracic ultrasound are other tools to consider when evaluating hemodynamic and interstitial components of congestion. However, the question of which and how many parameters must be used for this purpose, is still unanswered.

Inferior Vena Cava And Lung Ultrasound-guided Therapy For The Reduction Of Clinical Events In Acute Heart Failure - Caval Us-hf Trial

<h3>Introduction</h3> Readmissions for acute heart failure (AHF) are frequent, mostly due to persistent congestion on discharge. However, as the optimal evaluation of decongestion is not clearly defined, it is necessary to implement new tools to identify subclinical congestion to guide treatment. <h3>Objective</h3> To develop a therapeutic algorithm guided by lung (LUS) and inferior vena cava (IVC) ultrasound protocol in patients with AHF.Methods: Design of the interventions was carried out between August 2020-January 2021, and was developed in 3 phases: (1)Systematic and narrative review on the use of ultrasound-guided therapy, and treatments algorithms proposed by scientific societies; (2)Panel of experts for the creation of the CAVAL US protocol for the evaluation of right (VCI) and left (LUS) congestion and (3)Algorithms adaptation to our setting with the incorporation of CAVAL US protocol. <h3>Results</h3> Diuretic treatment algorithms were adapted and incorporated into the CAVAL US protocol as part of the daily congestion evaluation (Figure 1). The ultrasound results were divided into 3 categories (Figure 2): Group A) without or mild congestion, Group B) signs of moderate congestion, and Group C) severe signs of congestion and identified as poor prognostic factors. To define persistent congestion, we chose the cut-off point of >5 B lines, since it has been identified as a risk factor for rehospitalization due to AHF or death at six months; and for severe congestion >30 B lines were determined, as they predict hospitalization for HF or mortality at 90 days. <h3>Conclusion</h3> Through a systematic approach we have developed an evidence-based therapeutic algorithm to guide therapeutic interventions in the recently initiated CAVAL US randomized controlled trial. That will investigate whether lung and IVC ultrasound-guided therapy complementing clinical evaluation, reduces the combined end point of readmission, unplanned visit for worsening HF or death at 90 days in AHF.

ВОЗМОЖНОСТИ РАННЕЙ ДИАГНОСТИКИ ПЕРВИЧНОЙ ЦИЛИАРНОЙ ДИСКИНЕЗИИ

Despite the manifestations of primary ciliary dyskinesia (PCD) in the neonatal period or in the first year of life, the diagnosis of this rare disease is usually established at the age of 4–7 years. The aim of the study was to search for reserves for early diagnosis of PCD. Materials and methods of research: 17 patients were observed with PCD, confirmed on the basis of the PICADAR scale, highspeed light video microscopy (all patients) and transmission electron microscopy (in 3 patients) of the mucous biopsy of the respiratory membrane using a genetic study (in one patient). Results: all patients were born full-term; neonatal respiratory distress syndrome (RDS) was observed in 71% of patients; the median duration of mechanical ventilation/oxygen therapy was 14 [7; 21] days; lateralization abnormalities were found in 35% of patients; all patients had persistent nasal congestion and/or rhinorrhea, 94% had chronic or recurrent sinusitis, otitis, recurrent pneumonia, chest x-ray and computed tomography (CT) scans in 71% had atelectasis with constant localization in the middle lobe, 12 of 15 patients, traced in the follow-up, – bronchiectasis (BE), also mainly in the middle lobe (in 9 patients). The average age at diagnosis was 5 [1.75; 7] years, patients with an established diagnosis over the age of 3 years were more often diagnosed with BE. The median of PICADAR scores was 7 [6; 8] points. Conclusions: to establish early diagnosis of PCD, it is important to consider neonatal RDS, lateralization of organs, difficulty in nasal breathing, starting from the first half of life.

Acute Cardiointestinal Syndrome Resulting From Postoperative Acute Biventricular Heart Failure

ACUTELY DECOMPENSATED HEART FAILURE (HF), if left untreated, causes organ hypoperfusion that can progress to irreversible and life-threatening multiorgan dysfunction. Cardiointestinal syndrome (CIS) is the result of both persistent venous congestion and hypoperfusion of the intestines as a result of biventricular HF.1 These mechanisms contribute to perturbations in normal intestine function that ultimately result in intestinal bacteria product translocation into the bloodstream.2 This translocation causes inflammatory cytokine production and sepsis, which depress myocardial function and eventually lead to biventricular heart failure, multiorgan failure, and death.

TRAFFIC CONGESTIONS, TIME SPENT AT THE EXPRESSWAY JUNCTIONS, AND ITS IMPACT ON INDIVIDUAL PRODUCTIVITY: A PERCEPTION STUDY OF ILESA-OWO-BENIN EXPRESSWAY IN AKURE ONDO STATE, NIGERIA

The importance of the free flow of traffic, time spent in traffic at junctions, and individual productivity of road users along the Ilesa-Owo-Benin expressway in Akure Ondo State, Nigeria, cannot be overstated. While extant literature has shown that traffic congestion on roads significantly influences how road users perform their duties, few studies have explored the part played by the length of time they spend at junctions and how it impacts individual productivity. We collected data using a Questionnaire survey, comprising questions associated with traffic congestion at junctions of 203 respondents from across the residents (and travellers through Agbogbo/Irese/Futa junctions along Ilesa-Owo-Benin expressway in Akure). With an analysis of variance (ANOVA), we identified the differences in road users' perception of traffic congestions at junctions. We investigated the impact of traffic congestion on the productivity of road users. Finally, we identified potential solutions to the persistent traffic congestion experienced at the junctions. This paper offers a traffic congestion community with a better understanding of traffic congestions on road networks and aid in developing suitable methods and policies for road traffic congestion management.

Hypertonic saline solution and high dose of diuretic, ¿what do we know and how can we use them in persistent congestion?

The presence of decompensated heart failure continues to be a condition with high rates of hospitalization, impact on the health system, and quality of life for those who suffer it. The mainstay of treatment in these cases are diuretics. However, the resistance to this pharmacological group may occasionally occur, generating an inadequate negative fluid balance and persistence of congestion with negative clinical outcomes. Hypertonic saline solution with high doses of diuretic emerges as a therapeutic option for this group of patients with probable physiological, and clinical benefits on hospitalization and re-admission rates due to heart failure decompensation. A review of the most relevant aspects and benefits of this combination is discussed in this article.

Implications of Elevated Fibrosis-4 Index in Patients Receiving Trans-Catheter Aortic Valve Replacement.

Background: The prognostic implication of the fibrosis-4 index, which represents the degree of hepatic injury, on patients receiving trans-catheter aortic valve replacement (TAVR) remains unknown. Methods: Patients who underwent TAVR to treat severe aortic stenosis at our institute between 2015 and 2020 were included in this retrospective study and followed for 2 years from the index discharge. The impact of the fibrosis-4 index, which was calculated using age, hepatic enzymes, and platelet count, on 2-year heart failure readmissions was investigated. Results: A total of 272 patients (median age 85 (82, 88) years old, 76 (28%) men) were included. The median baseline fibrosis-4 index was 2.8 (2.2, 3.7). A high fibrosis-4 index (>3.79) was associated with higher cumulative incidence of the primary endpoint (18% versus 4%, p < 0.001) and higher event rates (0.1041 versus 0.0222 events/year, p < 0.001), with an adjusted hazard ratio of 1.27 (95% confidence interval 1.04–1.54, p = 0.019). Conclusion: an elevated fibrosis-4 index at baseline, indicating the existence of persistent hepatic congestion, was associated with incidences of heart failure following TAVR. Calculating the fibrosis-4 index before TAVR is highly encouraged for risk stratification and shared decision making.

Prognostic value of B lines detected with lung ultrasound in acute heart failure. A systematic review.

Pulmonary ultrasound is a simple diagnostic tool with immediate results for the assessment of pulmonary congestion in patients with heart failure (HF), allowing optimization of treatment by monitoring the dynamic changes identified. We aimed to evaluate the prognostic significance of the presence of B lines detected by lung ultrasound during hospitalization for heart failure. A search was conducted for scientific articles in PubMed, Embase, Google Scholar, and Cochrane databases including clinical trials, reviews, systematic reviews, and original articles that were related to the prognostic value of lung ultrasound in patients with HF in the last 5 years from 2016 to 2021. Studies including individuals aged ≥18 years evaluating the prognostic value of lung ultrasound in HF were included. Fourteen articles met inclusion criteria for analysis (three reviews, three systematic reviews with meta-analysis, six prospective studies, and two retrospective studies). The presence of more than 30-40 B lines at admission were considered a risk factor for readmission or mortality as was persistent pulmonary congestion with the presence of ≥15 B-lines. The presence of pulmonary congestion detected by lung ultrasound in acute heart failure has prognostic significance in terms of mortality and hospital readmission. Clinical trials are needed to evaluate whether diuretic therapy guided by lung ultrasound and the presence of B lines can reduce readmission and mortality in these patients.