Current Heart Failure Reports

, Volume 12, Issue 3, pp 215–222 | Cite as

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
Decompensated Heart Failure (JE Ho, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Decompensated Heart Failure


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.


Endothelial Heart failure 



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

Compliance with Ethics Guidelines

Conflict of Interest

Paolo C. Colombo, Amanda C. Doran, Duygu Onat, Ka Yuk Wong, Myra Ahmad, Hani N. Sabbah, and Ryan T. Demmer declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Paolo C. Colombo
    • 1
  • Amanda C. Doran
    • 1
  • Duygu Onat
    • 2
  • Ka Yuk Wong
    • 3
  • Myra Ahmad
    • 3
  • Hani N. Sabbah
    • 4
  • Ryan T. Demmer
    • 5
  1. 1.Division of Cardiology, College of Physicians & Surgeons, Department of MedicineColumbia UniversityNew YorkUSA
  2. 2.Division of Cardiology, College of Physicians & Surgeons, Department of MedicineColumbia UniversityNew YorkUSA
  3. 3.Division of Cardiology, College of Physicians & Surgeons, Department of MedicineColumbia UniversityNew YorkUSA
  4. 4.Division of Cardiovascular Medicine, Department of MedicineHenry Ford Heart and Vascular InstituteDetroitUSA
  5. 5.Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkUSA

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