Journal Article

The Role of Intra-Abdominal Pressure and Point of Care Ultrasound to Guide Decongestive Therapies in Acute Heart Failure

Crespo-Aznarez, S., Pérez-Silvestre, J., Méndez-Bailon, M., Vázquez-Ronda, M.A., Morales-Rull, J.L., García-Lorente, N., Montero-Hernandez, E., Serrano-Irigoyen, P., Pinilla, M.J., Rubio-Gracia, J., Fernández-Villa, N., Martínez-Gutiérrez, R., Cobo-Marcos, M., Campos-Saenz de Santamaría, A., Torres-Courchoud, I., Salamanca-Bautista, P., Torres-Macho, J., Llacer-Iborra, P., Josa-Laorden, C., Sánchez-Marteles, M., Trullas, J.C.

2025

Overview

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. The ABDOPOCUS-HF trial is a randomized, single-blind, low-intervention clinical trial (n = 168) investigating the utility of intra-abdominal pressure (IAP) and point of care ultrasound to guide decongestive therapies during the first 72 hours after admission for acute heart failure. The primary endpoint is significant congestion reduction at 72 hours, assessed through ADVOR score. Secondary outcomes include readmission/cardiovascular death at 90 days and changes in congestion biomarkers (NT-proBNP and CA125) and ultrasound parameters (B-lines, VEXUS score). Safety endpoints include electrolyte disturbances and worsening renal function during admission.

• Publisher: Oxford University Press,Wiley
• Subject: Abdomen / Acute Disease / Acute heart failure / Aged / Ascites / Biomarkers / Cardiovascular disease / Cardio‐renal syndrome / Clinical outcomes / Clinical trials / Creatinine / Diuretics / Diuretics - therapeutic use / Drug dosages / Electrolytes / Female / Heart failure / Heart Failure - drug therapy / Heart Failure - physiopathology / Heart Failure - therapy / Humans / Internal medicine / Intra‐abdominal pressure / Intubation / Male / Patients / Pleural effusion / Point of care testing / Point of care ultrasound / Point-of-Care Systems / Potassium / Sodium / Study Design / Ultrasonic imaging / Ultrasonography - methods / Urine