{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T18:30:15Z","timestamp":1790620215916,"version":"4.1.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":317,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T00:00:00Z","timestamp":1743984000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009687","name":"Uniwersytet Medyczny im. Piast\u00f3w Slaskich we Wroclawiu","doi-asserted-by":"publisher","award":["IDUB.A46B.24.002"],"award-info":[{"award-number":["IDUB.A46B.24.002"]}],"id":[{"id":"10.13039\/501100009687","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The dysfunctional lymphatic system appears to play an important role in the development and progression of congestion in heart failure. We hypothesized that in acute heart failure (AHF), diuretic efficacy is associated with peripheral lymph flow.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We prospectively studied AHF patients who received protocolized diuretics followed by assessment of lower limb flow using indocyanine green lymphangiography (a validated method for visualization of lymphatic drainage). The lymph flow was defined as \u2018present\u2019 when it reached the ankle and \u2018significant\u2019 when it reached &amp;gt;10\u2009cm within 10\u2009min of dye injection, respectively. Based on diuretic efficacy (defined as cumulative diuresis and weight loss), patients were classified as diuretic responders vs. non-responders. Overall, 65 patients (mean age: 67\u2009\u00b1\u200915\u2009years, median [Q1\u2013Q3] N-terminal pro-B-type natriuretic peptide: 6901 [4478\u201312\u2009723] pg\/ml) were examined. There were 43 (66%) diuretic responders and 22 (34%) non-responders who did not differ in baseline clinical\/laboratory characteristics. Among the responders, there were more patients with lymph flow either \u2018present\u2019 or \u2018significant\u2019 (95% vs. 73% and 88% vs. 45% vs non-responders, respectively, p\u2009&amp;lt;\u20090.01). Responders had significantly longer median distance lymph reached within 10\u2009min (50 [24\u201375] vs. 10 [3\u201338] cm; p\u2009&amp;lt;\u20090.0005). There was a significant association between lymph flow and 6-h diuresis with \u03b2 (standard error) of 0.45 (0.13) (p\u2009&amp;lt;\u20090.005). In the multivariable analyses, lymph flow distance (odds ratio 1.48, 95% confidence interval 1.08\u20132.03) independently predicted diuretic efficacy (p\u2009&amp;lt;\u20090.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>For the first time, faster lower limb lymph flow was linked with better diuretic efficacy in AHF. Studies are needed to determine whether the lymphatic system can become a therapeutic target for decongestion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.3655","type":"journal-article","created":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T22:26:02Z","timestamp":1744064762000},"page":"1136-1144","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Lower Extremity Lymphatic Flow is Associated with Diuretic Response in Acute Heart Failure"],"prefix":"10.1093","volume":"27","author":[{"given":"Barbara","family":"Ponikowska","sequence":"first","affiliation":[{"name":"Department of Physiology and Pathophysiology, Wroclaw Medical University , Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Zymli\u0144ski","sequence":"additional","affiliation":[{"name":"Institute of Heart Diseases, Wroclaw Medical University , Wroclaw ,","place":["Poland"]},{"name":"University Hospital in Wroclaw , Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marat","family":"Fudim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Duke University Medical Center , Durham, NC ,","place":["USA"]},{"name":"Duke Clinical Research Institute , Durham, NC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beata","family":"Ponikowska","sequence":"additional","affiliation":[{"name":"Department of Physiology and Pathophysiology, Wroclaw Medical University , Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gracjan","family":"Iwanek","sequence":"additional","affiliation":[{"name":"Institute of Heart Diseases, Wroclaw Medical University , Wroclaw ,","place":["Poland"]},{"name":"University Hospital in Wroclaw , Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mateusz","family":"Guzik","sequence":"additional","affiliation":[{"name":"Institute of Heart Diseases, Wroclaw Medical University , Wroclaw ,","place":["Poland"]},{"name":"University Hospital in Wroclaw , Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Biegus","sequence":"additional","affiliation":[{"name":"Institute of Heart Diseases, Wroclaw Medical University , Wroclaw ,","place":["Poland"]},{"name":"University Hospital in Wroclaw , Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,4,7]]},"reference":[{"key":"2026021721481944500_ejhf3655-bib-0001","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.jacc.2021.05.021","article-title":"Pathophysiology of the lymphatic system in patients with heart failure: JACC state-of-the-art review","volume":"78","author":"Itkin","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"2026021721481944500_ejhf3655-bib-0002","doi-asserted-by":"crossref","DOI":"10.1007\/s10741-024-10449-z","article-title":"Harnessing the lymphatic system","author":"Ponikowska","year":"2024","journal-title":"Heart Fail Rev"},{"key":"2026021721481944500_ejhf3655-bib-0003","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.jacc.2021.04.090","article-title":"Lymphatic dysregulation in patients with heart failure: JACC review topic of the week","volume":"78","author":"Fudim","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"2026021721481944500_ejhf3655-bib-0004","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1002\/ejhf.1533","article-title":"Controlled decongestion by reprieve therapy in acute heart failure: Results of the TARGET-1 and TARGET-2 studies","volume":"21","author":"Biegus","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2026021721481944500_ejhf3655-bib-0005","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/ejhf.2333","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). 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