The role of intra-abdominal pressure and point of care ultrasound to guide decongestive therapies in acute heart failure

Abstract

AIMS: Effective decongestion is crucial in managing acute decompensated heart failure (ADHF). Persistent congestion post-diuretic therapy correlates with adverse outcomes. This study evaluates whether a strategy guided by intra-abdominal pressure (IAP) and point-of-care ultrasound (POCUS) enhances decongestion compared to standard diuretic titration. METHODS AND RESULTS: ABDOPOCUS-HF is a randomized, multicentre, open-label, pragmatic clinical trial involving 168 patients hospitalized with ADHF across 14 Spanish hospitals. Inclusion criteria encompass clinical signs of congestion and elevated natriuretic peptides (NT-proBNP >1000 pg/mL or BNP > 250 pg/mL). Participants are randomized 1:1 to either standard care or an intervention arm where diuretic therapy is guided by baseline IAP measurements and POCUS assessments, including lung ultrasound, inferior vena cava diameter and VExUS score. The primary endpoint is the resolution of systemic congestion at 72 h, measured by the ADVOR score. Secondary endpoints include changes in pulmonary congestion (B-lines), intravascular congestion (VExUS and IVC), biomarkers (NT-proBNP and CA125), total diuretic dose, diuretic response, hospital length of stay and rates of cardiovascular death, rehospitalization and need for intravenous diuretics at 30 and 90 days. Safety endpoints encompass worsening renal function, electrolyte disturbances and catheter-related infections. CONCLUSIONS: The ABDOPOCUS-HF trial investigates whether integrating IAP and POCUS into decongestion strategies improves diuretic response and clinical outcomes in ADHF patients. Findings may inform future protocols for volume management in acute heart failure.