{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T10:10:54Z","timestamp":1780654254972,"version":"3.54.1"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T00:00:00Z","timestamp":1778889600000},"content-version":"vor","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Acute heart failure (AHF) is commonly regarded as a worsening stage of chronic heart failure (CHF), yet the haemodynamic transition to decompensation remains incompletely defined. This study evaluated whether a non-invasive physiology-guided approach based on venous return (VR)\u2013cardiac output (CO) balance can provide a framework to characterize transitional circulatory states preceding overt AHF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 193 patients with chronic heart failure, hypertensive heart disease, or AHF were analysed. Mean circulatory filling pressure and right atrial pressure were estimated non-invasively using inferior vena cava diameter indexed to body surface area and extracellular-to-total body water ratio, respectively. VR\u2013CO imbalance was quantified using a composite mismatch index.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The distribution of VR\u2013CO mismatch demonstrated a bimodal pattern on Gaussian mixture modelling, with two components (means \u00b1 SD: 2.25 \u00b1 .96 and 5.25 \u00b1 2.61). All overt AHF cases were localized within the higher-mismatch component. Intermediate states exhibited increasing mismatch while maintaining relatively preserved forward flow, consistent with buffered circulatory states. A subset of patients exhibited marked haemodynamic mismatch without clinical congestion, representing a highly buffered pre-decompensated state.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>AHF may represent a failure of circulatory compensation in which venous return loading exceeds the capacity of forward flow. A non-invasive VR\u2013CO framework reveals a continuum from compensated to buffered to overtly decompensated states and identifies a previously unrecognized highly buffered state preceding clinical deterioration. This physiology-guided approach may enable earlier detection of circulatory instability and provide a quantitative framework for risk stratification and therapeutic monitoring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eschf\/xvag139","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T12:06:15Z","timestamp":1778760375000},"source":"Crossref","is-referenced-by-count":0,"title":["Non-invasive quantification of haemodynamic imbalance in acute heart failure"],"prefix":"10.1093","volume":"13","author":[{"given":"Hiroshi","family":"Morishita","sequence":"first","affiliation":[{"name":"Department of Cardiology, Morishita Heart Clinic , 36 Donomae-cho, Kitashirakawa, Sakyo-ku, Kyoto 606-8277 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"2026060505461816900_xvag139-B1","volume-title":"Circulatory Physiology: Cardiac Output and Its 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