Pulmonary Congestion in Acute Heart Failure: From Hemodynamics to Lung Injury and Barrier Dysfunction Congestión pulmonar en la insuficiencia cardiaca aguda: de la hemodinámica a la lesión pulmonar y la disfunción de la barrera alveolocapilar

Acute heart failure (AHF) has been defined as new-onset or worsening heart failure (HF) signs and symptoms requiring urgent therapy. AHF is a leading cause of morbidity and mortality. Despite the considerable variation of clinical profiles and the substantial heterogeneity of underlying causes, the vast majority of patients with AHF present with symptoms and signs of pulmonary and systemic congestion rather than low cardiac output. Accordingly, dyspnea is the cardinal presenting symptom among patients hospitalized for AHF. Although many patients respond to initial therapy, a significant percentage do not experience early dyspnea relief. Additionally, there is dissociation between pulmonary capillary wedge pressure (PCWP) and dyspnea severity, such that patients with a high PCWP may be minimally dyspneic, while patients with a relatively lower PCWP may experience severe dyspnea. Moreover, the short-term mortality and readmission rate is up to 50%. These observations highlight the incomplete understanding of pulmonary congestion pathogenesis in AHF.