CONGRESS ABSTRACT

BACKGROUND the relationship between congestion and inflammation in heart failure is still challenging. Despite the literature, there is no definite data on the complex relationship between the two entities. AIMS We evaluated the relationship between peripheral and systemic inflammation before and after diuretic decongestion in patients with acute heart failure (AHF) and no sources for systemic infection.  METHODS: Peripheral congestion and systemic inflammation were assessed in 124 patients with AHF by means of bioimpendance vector analysis (Hydration Index, HI, %) and high-sensitivity c-reactive protein (hs-CRP), respectively. We assessed the variations in hsCRP plasma values and HI percentages between admission and discharge, after furosemide infusion. In relation to peripheral congestion, we categorized patients into dry and severely, moderately and mildly wet. RESULTS: At admission, hsCRP levels correlated with HI (r=0.22; P<0.02) and were significantly higher those patients with severely peripheral congestion as compared to other groups (post-hoc P<0.05). No association was with BNP values (rho=0.004; P=0.96). After 7 days (95%CI 6-8) in furosemide therapy, hsCRP and HI values significantly decreased from 11.9 (9.7– 13.4) to 7.9 mg/L (6.0 -9.5) and from 82.0 ± 6.1  to 77.4 ± 5.7 %, respectively. The changes in HI and hsCRP levels were significantly correlated (r=0.29; P=0.001). The reduction in hs-CRP levels was independent from BNP variations and furosemide doses and observed in group with severe peripheral congestion. CONCLUSIONS: Systemic inflammation is associated to severe peripheral congestion and decrease after furosemide therapy. This effect was not mediated by BNP modulation or potential anti-inflammatory effect of furosemide.  This finding suggest that peripheral interstitial fluid accumulation can drive systemic inflammation.