Myocellular and Interstitial Edema and Circulating Volume Expansion as a Cause of Morbidity and Mortality in Heart Failure

BackgroundTotal body sodium and volume overload are the hallmarks of the congested state in the heart failure patient and result in a variety of deleterious pathophysiologic outcomes including ventricular chamber dilation, passive congestion of both encapsulated and nonencapsulated vital organs and myocardial edema and ischemia.Methods and ResultsWe propose that congestion is itself a disease state irrespective of the underlying cardiac or renal dysfunction and that sodium and volume overload are directly related to poor clinical outcomes in such patients. In this model, the target of decongestion therapy should be normalization of total body sodium and volume in an expeditious manner and with a durable result.ConclusionsAdditionally, novel tools to continuously measure the effectiveness and adequacy of decongestion therapy in all compartments are required if improved clinical outcomes are to be attained.