Indocyanine inexperienced (ICG) lymphography in acute coronary heart failure sufferers (created in BioRender). Credit score: European Journal of Coronary heart Failure (2025). DOI: 10.1002/ejhf.3655
A brand new research printed within the European Journal of Coronary heart Failure reveals that the velocity of lymph circulation within the legs could decide how nicely sufferers reply to diuretics, a key remedy for acute coronary heart failure (AHF).
Researchers from Wroclaw Medical College and Duke College College of Medication discovered that sufferers with sooner lymphatic circulation of their decrease limbs skilled considerably higher diuretic responses, shedding new mild on the position of the lymphatic system in fluid stability and coronary heart failure therapy.
The lacking hyperlink in decongestion remedy
Coronary heart failure, a situation through which the center can’t pump sufficient blood to fulfill the physique’s wants, usually results in fluid buildup and swelling. Whereas diuretics assist take away extra water, some sufferers present little or no enchancment—a phenomenon often known as diuretic resistance.
The analysis group used indocyanine inexperienced (ICG) lymphography, a near-infrared fluorescent imaging approach, to visualise lymphatic circulation in 65 hospitalized AHF sufferers. Three hours after receiving customary furosemide therapy, sufferers underwent imaging of the decrease limbs to measure how shortly lymph fluid moved by the vessels.
The outcomes have been placing:
In 95% of responders, lymph circulation reached above the ankle inside 10 minutes, in comparison with 73% of non-responders.
Important lymph circulation (≥10 cm) was noticed in 88% of responders versus 45% of non-responders.
The median lymph circulation distance was 50 cm in responders and solely 10 cm in non-responders.
“Our research shows a clear link between faster lymph flow and a stronger diuretic response in acute heart failure,” stated Dr. Barbara Ponikowska, lead writer of the research. “It suggests that lymphatic efficiency may be a missing component in understanding why some patients fail to respond to standard therapies.”
Lymphatics: An ignored circulatory accomplice
The findings spotlight the lymphatic system as a vital but usually ignored participant in sustaining fluid stability. When diuretics draw water from the bloodstream, the lymphatic system should replenish plasma quantity by returning interstitial fluid. If lymphatic transport is sluggish, diuresis stalls—very like a pump working dry as a result of the drainpipe is blocked.
The research additionally revealed that increased aldosterone ranges, a hormone recognized to advertise salt and water retention, have been related to slower lymph circulation and poorer therapy outcomes. This will likely open new therapeutic pathways combining diuretic and hormonal modulation methods.
“By targeting lymphatic function, we may be able to support decongestion more effectively and personalize therapy for heart-failure patients,” Dr. Ponikowska added.
Though preliminary and restricted by its single-center design, the research introduces lymphatic circulation as a possible biomarker and therapeutic goal in acute coronary heart failure. Future analysis will intention to develop noninvasive, real-time monitoring instruments for lymphatic circulation, applied sciences that might remodel the way in which clinicians assess and handle fluid overload.
Extra info:
Barbara Ponikowska et al, Decrease extremity lymphatic circulation is related to diuretic response in acute coronary heart failure, European Journal of Coronary heart Failure (2025). DOI: 10.1002/ejhf.3655
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Wroclaw Medical College
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Sooner lymph circulation within the legs is linked to a greater response to diuretics in acute coronary heart failure sufferers (2025, October 8)
retrieved 8 October 2025
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