{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:55:37Z","timestamp":1789498537885,"version":"build-2803163510"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:00:00Z","timestamp":1758585600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background and aims<\/jats:title><jats:p>Pulmonary and\/or peripheral venous congestion defines the clinical diagnosis of acute heart failure (AHF). However, the systolic pulmonary arterial pressure (sPAP) thresholds at which pulmonary (chest x-ray) and inferior vena cava (IVC) congestion occur are not well established. This study aimed to identify a cut-off value of sPAP that reliably indicates AHF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>We retrospectively included 380 consecutive patients hospitalized for AHF at an Italian referral centre, after excluding those with severe tricuspid regurgitation. Receiver operating characteristic (ROC) curve analysis and Youden's J statistic identified a threshold of sPAP\u2009\u2265\u200948.75\u2005mmHg as the most accurate in predicting both pulmonary (sensitivity\u2009=\u200989.9%, specificity\u2009=\u200973%) and peripheral (sensitivity\u2009=\u200988.3%, specificity\u2009=\u200982.5%) fluid overload. The association between this sPAP threshold and both pulmonary and peripheral congestion was confirmed by chi-square testing (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001) and multivariate logistic regression (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). After adjustment for confounders, sPAP\u2009\u2265\u200949\u2005mmHg was independently associated with all-cause death or heart failure (HF) hospitalization (HR\u2009=\u20091.713; 95% CI 1.127\u20132.602; <jats:italic>p<\/jats:italic>\u2009=\u20090.012).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>sPAP threshold of 49 mmHg identifies congestion with clinically useful accuracy\u2014pulmonary (chest X-ray) congestion.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1678712","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T05:32:21Z","timestamp":1758605541000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Systolic pulmonary artery pressure threshold to define pulmonary and peripheral congestion in acute heart failure in absence of severe tricuspid regurgitation"],"prefix":"10.3389","volume":"12","author":[{"given":"Maria Giulia","family":"Bellicini","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,23]]},"reference":[{"key":"B1","volume-title":"Braunwald\u2019s Heart Disease: A Textbook of Cardiovascular Medicine","author":"Braunwald","year":"2019"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.1016\/S2213-2600(21)00072-2","article-title":"Mildly elevated pulmonary artery systolic pressure on echocardiography: bridging the gap in current guidelines","volume":"9","author":"Jankowich","year":"2021","journal-title":"Lancet Respir Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1533","DOI":"10.1378\/chest.13-0296","article-title":"Point: can Doppler echocardiography estimates of pulmonary artery systolic pressures be relied upon to accurately make the diagnosis of pulmonary hypertension? Yes","volume":"143","author":"Rudski","year":"2013","journal-title":"Chest."},{"key":"B4","doi-asserted-by":"publisher","first-page":"2797","DOI":"10.1161\/hc4801.100076","article-title":"Clinical correlates and reference intervals for pulmonary artery systolic pressure among echocardiographically normal subjects","volume":"104","author":"McQuillan","year":"2001","journal-title":"Circulation"},{"key":"B5","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1164\/rccm.200811-1691OC","article-title":"Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension","volume":"179","author":"Fisher","year":"2009","journal-title":"Am J Respir Crit Care Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1214","DOI":"10.1002\/ejhf.1862","article-title":"Pulmonary hypertension and right ventricular dysfunction in heart failure: prognosis and 15-year prospective longitudinal trajectories in survivors","volume":"22","author":"Santiago-Vacas","year":"2020","journal-title":"Eur J Heart Fail."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1793","DOI":"10.3390\/life13091793","article-title":"Pulmonary hypertension in left ventricular valvular diseases: a comprehensive review on pathophysiology and prognostic value","volume":"13","author":"Velidakis","year":"2023","journal-title":"Life."},{"key":"B8","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1002\/ejhf.1369","article-title":"The use of diuretics in heart failure with congestion \u2014 a position statement from the Heart Failure Association of the European Society of Cardiology.","volume":"21","author":"Mullens","year":"2019","journal-title":"Eur J Heart Fail."},{"key":"B9","doi-asserted-by":"publisher","first-page":"2245","DOI":"10.1016\/j.jcin.2023.07.040","article-title":"Stressed blood volume in severe tricuspid regurgitation: implications for transcatheter treatment.","volume":"16","author":"Rommel","year":"2023","journal-title":"JACC Cardiovasc Interv."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1004","DOI":"10.1002\/ejhf.3235","article-title":"Congestion patterns in severe tricuspid regurgitation and transcatheter treatment: insights from a multicentre registry.","volume":"26","author":"Rommel","year":"2024","journal-title":"Eur J Heart Fail."},{"key":"B11","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1093\/ehjci\/jev014","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging","volume":"16","author":"Lang","year":"2015","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"B12","doi-asserted-by":"publisher","first-page":"3618","DOI":"10.1093\/eurheartj\/ehac237","article-title":"2022 ESC\/ERS guidelines for the diagnosis and treatment of pulmonary hypertension.","volume":"43","author":"Humbert","year":"2022","journal-title":"Eur Heart J."},{"key":"B13","doi-asserted-by":"publisher","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"key":"B14","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.echo.2016.01.011","article-title":"Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update","volume":"29","author":"Nagueh","year":"2016","journal-title":"J Am Soc Echocardiogr"},{"key":"B15","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/1476-7120-12-25","article-title":"How I do it: lung ultrasound","volume":"12","author":"Gargani","year":"2014","journal-title":"Cardiovasc Ultrasound"},{"key":"B16","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1093\/eurheartj\/ehv745","article-title":"Dynamic changes and prognostic value of pulmonary congestion by lung ultrasound in acute and chronic heart failure: a systematic review","volume":"37","author":"Platz","year":"2016","journal-title":"Eur Heart J"},{"key":"B17","volume-title":"Principles and Practice of Echocardiography","author":"Weyman","year":"1994"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1678712\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T05:32:23Z","timestamp":1758605543000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1678712\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,23]]},"references-count":17,"alternative-id":["10.3389\/fcvm.2025.1678712"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2025.1678712","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,23]]},"article-number":"1678712"}}