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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EA leadoff symposium at Heart Failure 2014 provided an update on the diagnosis of acute heart failure (AHF). This article provides an overview of the clinical assessment of AHF, which is an increasingly common cause of hospitalization and death, as well as point-of-care pulmonary ultrasound in assessing pulmonary congestion, biomarkers in the diagnosis of AHF, and an overview of the assessment and monitoring of congestion using noninvasive devices.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Genomics\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EImaging Modalities\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Genomics\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EImaging Modalities\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EA leadoff symposium at Heart Failure 2014 provided an update on the diagnosis of acute heart failure (AHF). Stavros Kakouros, MD, Fleming Hospital, Athens, Greece, provided an overview of the clinical assessment of AHF, which is an increasingly common cause of hospitalization and death. Early diagnosis is crucial in reducing both. Diagnosis can be challenging since AHF can be caused by any structural or functional cardiac disorder that impedes normal ventricle function. The majority of AHF cases are due to further deterioration in patients with chronic heart failure (HF) with preserved or reduced ejection fraction (pEF or rEF), although AHF can be the first manifestation of cardiac trouble.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAssessment for patients with apparent AHF should be immediate and should involve\u003C\/p\u003E\u003Cul class=\u0022list-simple \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n            \n            \u003Cp id=\u0022p-4\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003Ehistory\u2014including age, sex, symptoms (dyspnea, orthopnea, fatigue), clinical signs (eg, edema), medical history (eg, coronary artery disease), medications (eg, diuretics), and comorbidities;\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n            \n            \u003Cp id=\u0022p-5\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003Eclinical examination focusing on vital signs (blood pressure, heart rate, respiratory rate), appearance of jugular vein, heart and lungs, abdomen, and extremities;\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n            \n            \u003Cp id=\u0022p-6\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003Eelectrocardiography;\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n            \n            \u003Cp id=\u0022p-7\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003Eradiograph of the chest;\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n            \n            \u003Cp id=\u0022p-8\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003Einitial laboratory tests, including complete blood count, serum electrolytes, liver function, renal function, serum glucose, thyroid stimulating hormone, urinalysis, troponin, B-type natriuretic peptide (BNP), and arterial blood gases; and\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-6\u0022\u003E\n            \n            \u003Cp id=\u0022p-9\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003Eechocardiography.\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-10\u0022\u003EHospitalization based on AHF is typically due to\u003C\/p\u003E\u003Cul class=\u0022list-simple \u0022 id=\u0022list-2\u0022\u003E\u003Cli id=\u0022list-item-7\u0022\u003E\n            \n            \u003Cp id=\u0022p-11\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003Enot using medication,\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-8\u0022\u003E\n            \n            \u003Cp id=\u0022p-12\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003Enot adhering to a diet,\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-9\u0022\u003E\n            \n            \u003Cp id=\u0022p-13\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003Eacute myocardial ischemia,\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-10\u0022\u003E\n            \n            \u003Cp id=\u0022p-14\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003Euncontrolled hypertension,\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-11\u0022\u003E\n            \n            \u003Cp id=\u0022p-15\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003Eatrial fibrillation or other arrhythmias,\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-12\u0022\u003E\n            \n            \u003Cp id=\u0022p-16\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003Erecent addition of negative inotropic compounds,\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-13\u0022\u003E\n            \n            \u003Cp id=\u0022p-17\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003Epulmonary emboli,\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-14\u0022\u003E\n            \n            \u003Cp id=\u0022p-18\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003Ealcohol overconsumption or illicit drug use,\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-15\u0022\u003E\n            \n            \u003Cp id=\u0022p-19\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003Ethyroid dysfunction, or\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-16\u0022\u003E\n            \n            \u003Cp id=\u0022p-20\u0022\u003E\u003Cspan class=\u0022list-label\u0022\u003E\u25aa \u003C\/span\u003Einfections.\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-21\u0022\u003ESix clinical phenotypes can be present (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/12\/4\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Clinical Phenotypes of Acute Heart Failure at Presentation\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-90525182\u0022 data-figure-caption=\u0022Clinical Phenotypes of Acute Heart Failure at Presentation\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/12\/4\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/12\/4\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/12\/4\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14369\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-22\u0022 class=\u0022first-child\u0022\u003EClinical Phenotypes of Acute Heart Failure at Presentation\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EACS=acute coronary syndrome; AH=arterial hypertension; EF=ejection fraction; HF=heart failure; HF-pEF=heart failure with preserved ejection fraction; JVD=jugular vein distension; LHF=left heart failure; MR=mitral regurgitation.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from S Kaouros, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-23\u0022\u003EThe diagnosis of HF-rEF and HF-pEF requires symptoms and signs typical of HF. HF-rEF also requires reduced left ventricle ejection fraction, and HF-pEF also requires normal or mildly reduced left ventricle ejection fraction and nondilated left ventricle, as well as relevant structural heart disease (left ventricle hypertrophy, left atrial enlargement, or abnormal diastolic function). Clinical and hemodynamic congestion can be important in diagnosing AHF [Martin G et al. \u003Cem\u003EChest\u003C\/em\u003E 2002]. Blood pressure can be elevated, normal, or low. Hypotension is ominous, as it may reflect low cardiac output. Jugular vein distention can be key to diagnosis [Stevenson LW, Perloff JK. \u003Cem\u003EJAMA\u003C\/em\u003E 1989]. BNP \u003Cem\u003Ecan also be crucial in diagnosing HF, but it should not be used alone\u003C\/em\u003E.\u003C\/p\u003E\u003Cp id=\u0022p-24\u0022\u003EPeter S. Pang, MD, MSc, Indiana University School of Medicine, Indianapolis, Indiana, USA, discussed point-of-care pulmonary ultrasound in assessing pulmonary congestion. Relief of congestion is a major goal of therapy [Mebazaa A et al. \u003Cem\u003ECrit Care Med\u003C\/em\u003E 2010; Picano et al. \u003Cem\u003EHeart Fail Rev\u003C\/em\u003E 2010], but a study of more than 150,000 patients indicated that about 20% can have incomplete relief from congestion at discharge [Yancy CW. \u003Cem\u003ERev CV Med\u003C\/em\u003E 2006].\u003C\/p\u003E\u003Cp id=\u0022p-25\u0022\u003ECurrently, there is no universally agreed-on assessment of the severity congestion that is easily reproducible and valid across users. Point-of-care ultrasound, which can be done with a handheld device, may be useful [Moore CL, Copel JA. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2011]. B-lines are ultrasound lung comets that are reverberation artifacts from the pleural line. Nonetheless, they are valuable since they are caused by the presence of fluid in the lung, as in acute pulmonary edema. Absence of B-lines conclusively excludes cardiogenic pulmonary edema [Neskovic AN et al. \u003Cem\u003EEur Heart J Cardiovasc Imaging\u003C\/em\u003E 2013]. The number of B-lines determined from the ultrasound image relates to the severity of extravascular lung water [Picano E et al. \u003Cem\u003EJ Am Soc Echocardiogr\u003C\/em\u003E 2006]. Detecting and quantifying B-lines is a straightforward process that is easy to learn, with quality results being produced by personnel even after only 1 training session of \u0026lt;1 hour [Bedetti G et al. \u003Cem\u003ECardiovasc Ultrasound\u003C\/em\u003E 2006].\u003C\/p\u003E\u003Cp id=\u0022p-26\u0022\u003EChristian Mueller, MD, University Hospital, Basel, Switzerland, discussed biomarkers in the diagnosis of AHF. Teasing out whether acute dyspnea is due to AHF or other conditions, such as chronic obstructive pulmonary disease, asthma, or pulmonary embolism, can be challenging given the lack of specificity and sensitivity or symptoms and signs. The consequence can be uncertainty in establishing whether a patient is at risk of HF, which increases mortality and costs of care [McCullough P et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2002].\u003C\/p\u003E\u003Cp id=\u0022p-27\u0022\u003EBNP is a marker of HF occurrence and severity, although it cannot discriminate among dysfunctions in left and right ventricles or heart valves [Maisel A et al. \u003Cem\u003EEur J Heart Fail\u003C\/em\u003E 2008]. It does improve diagnostic accuracy when used in the emergency department\u0027s detection of HF [Maisel A. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2002]. BNP also improves patient management in terms of time to adequate therapy, and it reduces hospitalization and days of hospitalization, intensive care unit stay, and costs of care [Mueller C et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2004]. BNP detection should not be used for diagnosis in patients suffering from shock, since their BNP levels can be elevated for reasons other than AHF. The latest European Society of Cardiology guidelines incorporate BNP detection into the diagnostic workup of patients with suspected AHF (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E) [McMurray JJ et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/12\/4\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022European Society of Cardiology Guidelines for Suspected Acute Heart Failure\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-90525182\u0022 data-figure-caption=\u0022European Society of Cardiology Guidelines for Suspected Acute Heart Failure\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/12\/4\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/12\/4\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/12\/4\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14371\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-28\u0022 class=\u0022first-child\u0022\u003EEuropean Society of Cardiology Guidelines for Suspected Acute Heart Failure\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003E*In the acute setting, MR-proANP may also be used (cut-off point 120 pmol\/L, ie \u0026lt;120 pmol\/L=HF unlikely); \u003Csup\u003Ea\u003C\/sup\u003E Exclusion cut-off points for natriuretic peptides are chosen to minimize the false-negative rate while reducing unnecessary referrals for echocardiography; \u003Csup\u003Eb\u003C\/sup\u003E Other causes of elevated natriuretic peptide levels in the acute setting are an acute coronary syndrome, atrial or ventricular arrhythmias, pulmonary embolism, and severe chronic obstructive pulmonary disease with elevated right heart pressures, renal failure, and sepsis. Other causes of an elevated natriuretic level in the non-acute setting are: old age (\u0026gt;75 years), atrial arrhythmias, left ventricular hypertrophy, chronic obstructive pulmonary disease, and chronic kidney disease; \u003Csup\u003Ec\u003C\/sup\u003E Treatment may reduce natriuretic peptide concentration, and natriuretic peptide concentrations may not be markedly elevated in patients with HF-PEF.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-4\u0022\u003EBNP=B-type natriuretic peptide; ECG=electrocardiogram; ED=erectile dysfunction; HF=heart failure; MR-proANP=mid-regional pro atrial natriuretic peptide; NT-proBNP=N-terminal pro B-type natriuretic peptide.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-5\u0022\u003EReproduced from McMurray JJ et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2012;33(14):1787\u20131847. With permission from Oxford University Press.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-29\u0022\u003EFinally, it is clear that biomarkers can be valuable in obese patients, who are at increased risk of AHF, and that systemic infection can be a common trigger of HF.\u003C\/p\u003E\u003Cp id=\u0022p-30\u0022\u003EAndrew Coates, MD, Monash University, Monash, Australia, provided a brief overview of the assessment and monitoring of congestion using noninvasive devices. Echo techniques, including echocardiography, are proven strategies. However, they can be lengthy and offer only indirect information. Use of natriuretic peptides is limited because of their half-lives, which may be insufficient for acute event monitoring, and because they are affected by patient characteristics such as age, sex, body weight, and renal function. Thoracic impedance monitoring has potential merit. Further out on the horizon are lung ultrasonography and remote dielectric sensing.\u003C\/p\u003E\u003Cp id=\u0022p-31\u0022\u003EOne of the reasons for the interest in noninvasive strategies is that invasive hemodynamic monitoring is not recommended by organizations, including the Heart Failure Society of America and the European Society of Cardiology. Furthermore, the reliability of individual clinical signs of congestion is not diagnostically robust [Gheorghiade M et al. \u003Cem\u003EEur J Heart Fail\u003C\/em\u003E 2010].\u003C\/p\u003E\u003Cp id=\u0022p-32\u0022\u003ENoninvasive monitoring of HF-related congestion is still largely in the realm of clinical assessment. Routine use in diagnosis requires clinical trials. Novel technologies are potentially useful, if they are proved to add value to clinical assessments. 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