Fluid re-distribution rather than accumulation causes most cases of decompensated heart failure

摘要

Dr. Gheorghiade and colleagues' recent review (1) pertaining to re-hospitalization for heart failure (HF) is based largely upon the disputed assumption that increases in total body salt and water underlie the congestive presentation. Mounting evidence suggests that this assumption is likely incorrect for most patients, and may explain the failure of multiple drugs and devices targeting reduction of total body salt and water to reduce rehospitalization risk and HF mortality. For accumulation of total body salt and water to be the basis of worsening HF, increases in weight would necessarily be evident early in the course leading up to a hospitalization for HF (HHF). Studies instead have documented that the majority of patients gain little or no weight before HHF (2-4), despite the fact that filling pressures rise significantly (4). Furthermore, when weight gain occurs, it does so shortly before HHF (2), long after filling pressures have begun to rise. Although Dr. Gheorghiade et al. (5) have previously acknowledged this lack of evidence for weight gain before HHF, their current review has ignored this "inconvenient truth" and focused mainly on reducing total body volume and treating comorbidities.