Cuthbert JJ, Pellicori P, Flockton R, et al. - Patients carrying clinical risk factors for heart failure (HF) commonly have ultrasound (US)-detected subclinical evidence of congestion.

• This study involved 238 patients with at least one clinical risk factor for HF.

• The following three US variables were used to examine prevalence and clinical links of subclinical congestion: (i) inferior vena cava (IVC) diameter; (ii) jugular vein distensibility (JVD) ratio (the ratio of the jugular vein diameter during the Valsalva manoeuvre to that at rest); (iii) the number of B-lines from a 28-point lung US.

• Subclinical congestion prevalence (defined as at least one positive US marker of congestion) was estimated to be 30% (13% by IVC diameter, 9% by JVD ratio and 13% by B-line quantification).

• Larger left atria and higher plasma levels of natriuretic peptides were observed in patients with at least one marker vs those with no congestion on US.

• A lower JVD ratio (7.69 vs 8.80) and more often presence of at least one lung B-line (74% vs 63%) was identified in patients with elevated plasma N-terminal pro-B-type natriuretic peptide/B-type natriuretic peptide.

• However, there was more close association of plasma natriuretic peptide levels with left atrial volume than other US measures of congestion.