The Year in Cardiology

Heart Failure: the Year in Cardiology 2019

John G.F. Cleland; Alexander R. Lyon; Theresa McDonagh; John J.V. McMurray


Eur Heart J. 2020;41(12):1232-1248. 

In This Article


Congestion lies at the heart of failure.[25–27] Imaging has long been used to identify dilation of the atria and venous system, which might be termed haemodynamic congestion, for which natriuretic peptides are a useful biomarker.[25] More recently imaging has been used to identify accumulation of fluid in tissues (tissue congestion),[25,28–32] which may be associated with increases in the biomarker, (bio)-adrenomedullin.[33] Imaging and biomarkers in combination are both sensitive and specific for detecting a failing heart, a useful guide to the severity of congestion and prognosis and a potential therapeutic target indicating successful management. Imaging remains the preferred method for identifying the cause of heart failure. If congestion is central to the management of heart failure, then better monitoring[34] and more effective (diuretic) interventions (perhaps acetazolamide?[35]) should improve outcome (Take home figure).

Take home figure.

Two-year cause-specific mortality and non-fatal vascular events for patients with cardiovascular disease according to New York Heart Association (NYHA) class. Numbers and proportions are a conceptual representation of absolute and relative risk and are not strictly evidence-based. Note that for patients in NYHA Class 4, interventions for sudden arrhythmic death may be ineffective or fail to lead to a meaningful prolongation of life because the patient is likely soon to die of worsening heart failure. CRD, congestion-related death, otherwise called death due to worsening heart failure; NFVE, non-fatal vascular event (e.g. myocardial infarction and stroke; note that events are more likely to be suddenly fatal as heart failure progresses); non-CVD, non-cardiovascular death; RSAD, resuscitatable sudden arrhythmic death; SVD, sudden vascular death; TSAD, terminal (non-resucitatable) sudden arrhythmic death. Reproduced with permission from ref.59