Venous congestion, endothelial and neurohormonal activation in acute decompensated heart failure: cause or effect?

Current Heart Failure Reports
Paolo C ColomboRyan T Demmer

Abstract

Venous congestion and endothelial and neurohormonal activation are known to occur in acute decompensated heart failure (ADHF), yet the temporal role of these processes in the pathophysiology of decompensation is not fully understood. Conventional wisdom presumes congestion to be a consequence of worsening cardiovascular function; however, the biomechanically driven effects of venous congestion are biologically plausible contributors to ADHF that remain largely unexplored in vivo. Recent experimental evidence from human models suggests that fluid accumulation and venous congestion are not simply consequences of poor cardiovascular function, but rather are fundamental pro-oxidant, pro-inflammatory, and hemodynamic stimuli that contribute to acute decompensation. The latest advances in the monitoring of volume status using implantable devices allow for the detection of venous congestion before symptoms arise. This may ultimately lead to improved treatment strategies including not only diuretics, but also specific, adjuvant interventions to counteract endothelial and neurohormonal activation during early preclinical decompensation.

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Citations

Nov 7, 2015·Revista clínica española·M Sánchez-MartelesI Giménez López
Jun 5, 2015·European Journal of Heart Failure·Alexandre MebazaaFaiez Zannad
Apr 10, 2018·The Korean Journal of Internal Medicine·Pieter Martens, Wilfried Mullens
May 17, 2018·Journal of the American Society of Nephrology : JASN·Shweta BansalStuart Linas
May 17, 2017·Heart Failure Reviews·Nikolaos P E KadoglouJohn Parissis
Mar 7, 2020·Nature Reviews. Disease Primers·Mattia ArrigoAlexandre Mebazaa
Oct 22, 2015·Current Heart Failure Reports·Pieter MartensWilfried Mullens
Sep 28, 2017·Heart Failure Reviews·Hani N Sabbah
Feb 10, 2021·Expert Opinion on Pharmacotherapy·Bharat NarasimhanWilbert S Aronow
Feb 8, 2021·British Journal of Anaesthesia·Marcos G LopezFrederic T Billings
Jul 12, 2020·Journal of Cardiac Failure·Masayoshi YamamotoMasaki Ieda
Oct 11, 2020·Journal of Cardiac Failure·Rafael De La EspriellaUNKNOWN IMPROVE-HF Investigators
Aug 3, 2021·Veterinary Clinical Pathology·Flavio H AlonsoPaulo R O Paes

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