Evidence map›Paper›PMID 41215726›Full record

Trial reportEuropean journal of heart failure2025

Clinical profiles and prognostic impact of residual intravascular and tissue congestion in acute heart failure.

Daan C H Ceelen, Jozine M Ter Maaten, Geert H D Voordes, Gad Cotter, Beth A Davison, Gerasimos Filippatos, Peter S Pang, Claudio Gimpelewicz, John G F Cleland, G Michael Felker and 6 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in European journal of heart failure, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Review
  2. Article
  3. Article
  4. Review
  5. Review
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Daan C H CeelenUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands.ORCID https://orcid.org/0000-0003-1670-2165
Jozine M Ter MaatenUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands.ORCID https://orcid.org/0000-0002-4910-9336
Geert H D VoordesUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands.ORCID https://orcid.org/0000-0001-8403-0562
Gad CotterMomentum Research, Durham, NC, USA.ORCID https://orcid.org/0000-0002-9613-3339
Beth A DavisonMomentum Research, Durham, NC, USA.ORCID https://orcid.org/0000-0003-2374-6449
Gerasimos FilippatosDepartment of Cardiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.ORCID https://orcid.org/0000-0002-5640-0332
Peter S PangDepartment of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Claudio GimpelewiczNovartis Pharma, Basel, Switzerland.
John G F ClelandSchool of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
G Michael FelkerDivision of Cardiology, Department of Medicine, Duke University, Durham, NC, USA.
Barry GreenbergUniversity of California San Diego Health, Sulpizio Cardiovascular Institute, La Jolla, CA, USA.
Michael M GivertzDivision of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Christopher M O'ConnerInova Heart and Vascular Institute, Falls Church, VA, USA.
John R TeerlinkSection of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, CA, USA.
Marco MetraDepartment of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.
Adriaan A VoorsUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsResidual congestion (RC) is common at discharge after acute decompensated heart failure (ADHF) and is associated with early mortality and rehospitalization. The prognostic value of distinct RC phenotypes (i.e. intravascular and tissue congestion) remains unclear. This analysis investigated RC phenotypes and their outcomes. METHODS AND

resultsPatients with congestion at admission from two large ADHF trials, PROTECT (rolofylline; index) and RELAX-AHF-2 (serelaxin; replication), were classified based on clinical signs at day 7/discharge as intravascular (jugular venous pressure) or tissue (pulmonary rales/peripheral oedema) congestion, each alone, combined or neither. Cox regression assessed 180-day mortality after adjusting for risk factors. Overall, 1557 patients with predominantly combined (i.e. tissue and intravascular) congestion at admission were included, with a median age of 72 years. By day 7 or discharge, 580 (37%) patients had RC. In these patients, intravascular congestion (n = 260; 45%) was most common, followed by combined (n = 185; 32%) and tissue (n = 135; 23%) congestion. During hospitalization, patients with solely intravascular RC had greater diuretic responses, shorter hospital stays and received lower doses of intravenous loop diuretics than those with tissue or combined congestion (all p < 0.05). Residual intravascular and tissue congestion were independently associated with increased 180-day mortality (hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.15-2.49, and HR 2.07, 95% CI 1.25-3.41, respectively) compared to decongested patients. In the RELAX-AHF-2 substudy (n = 476), similar findings were observed.

conclusionsPatients with intravascular RC had better diuretic responses and shorter hospital stays than those with tissue/combined RC, but worse outcomes than decongested patients. This study highlights the importance of RC assessment to identify at-risk patients. Future studies should evaluate phenotype-guided treatments.

Indexed as

Heart FailureAcute DiseaseAgedAged, 80 and overDiureticsFemaleHumansMaleMiddle AgedPrognosisXanthinesDiureticsrolofyllineXanthinesAcute heart failureCongestionDiureticsPhenotypesPrognosis

Identifiers

PMID41215726
PMCPMC12803611

What Socratic holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.