Venous Congestion, Endothelial and Neurohormonal Activation in Acute Decompensated Heart Failure: Cause or Effect?

Paolo C. Colombo, Amanda C. Doran, Duygu Onat, Ka Yuk Wong, Myra Ahmad, Hani N. Sabbah, Ryan T. Demmer

Research output: Contribution to journalReview articlepeer-review

42 Scopus citations


Venous congestion and endothelial and neurohormonal activation are known to occur in acute decompensated heart failure (ADHF), yet the temporal role of these processes in the pathophysiology of decompensation is not fully understood. Conventional wisdom presumes congestion to be a consequence of worsening cardiovascular function; however, the biomechanically driven effects of venous congestion are biologically plausible contributors to ADHF that remain largely unexplored in vivo. Recent experimental evidence from human models suggests that fluid accumulation and venous congestion are not simply consequences of poor cardiovascular function, but rather are fundamental pro-oxidant, pro-inflammatory, and hemodynamic stimuli that contribute to acute decompensation. The latest advances in the monitoring of volume status using implantable devices allow for the detection of venous congestion before symptoms arise. This may ultimately lead to improved treatment strategies including not only diuretics, but also specific, adjuvant interventions to counteract endothelial and neurohormonal activation during early preclinical decompensation.

Original languageEnglish (US)
Pages (from-to)215-222
Number of pages8
JournalCurrent Heart Failure Reports
Issue number3
StatePublished - Jun 1 2015

Bibliographical note

Funding Information:
This study was supported by the A. L. Mailman Family Foundation, NIH Grant Number HL092144 and NIH Grant Number DE018739.

Publisher Copyright:
© 2015, Springer Science+Business Media New York.


  • Endothelial
  • Heart failure


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