Venous Congestion, Endothelial and Neurohormonal Activation in Acute Decompensated Heart Failure: Cause or Effect?

Colombo, P.C.; Doran, Amanda C.; Onat, Duygu; Wong, K.; Ahmad, Myra; Sabbah, Hani N.; Demmer, Ryan T.

doi:10.1007/s11897-015-0254-8

Cited by 49 publications

(35 citation statements)

References 74 publications

(60 reference statements)

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“…Some patients also seem to suffer from vasoconstriction and fluid misdistribution rather than pure volume overload, probably requiring an individualized, more vasodilative treatment approach 8, 9, 20. Decongestive therapy may also be halted owing to assumed adverse events, mainly kidney injury, which may theoretically occur as a result of excess diuretic therapy 21.…”

Section: Discussionmentioning

confidence: 99%

Focused echocardiography and lung ultrasound protocol for guiding treatment in acute heart failure

et al. 2017

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AimsThere is little evidence‐based therapy existing for acute heart failure (AHF), hospitalizations are lengthy and expensive, and optimal monitoring of AHF patients during in‐hospital treatment is poorly defined. We evaluated a rapid cardiothoracic ultrasound (CaTUS) protocol, combining focused echocardiographic evaluation of cardiac filling pressures, that is, medial E/e′ and inferior vena cava index, with lung ultrasound (LUS) for guiding treatment in hospitalized AHF patients.Methods and resultsWe enrolled 20 consecutive patients hospitalized for AHF, whose in‐hospital treatment was guided using the CaTUS protocol according to a pre‐specified treatment protocol targeting resolution of pulmonary congestion on LUS and lowering cardiac filling pressures. Treatment results of these 20 patients were compared with those of a standard care sample of 100 patients, enrolled previously for follow‐up purposes. The standard care sample had CaTUS performed daily for follow‐up and received standard in‐hospital treatment without ultrasound guidance. All CaTUS exams were performed by a single experienced sonographer. The CaTUS‐guided therapy resulted in significantly larger decongestion as defined by reduction in symptoms, cardiac filling pressures, natriuretic peptides, cumulative fluid loss, and resolution of pulmonary congestion (P < 0.05 for all) despite a shorter mean length of hospitalization. Congestion parameters were significantly lower also at discharge (P < 0.05 for all), without any significant difference in these parameters on admission. The treatment arm displayed better survival regarding the combined endpoint of 6 month all‐cause death or AHF re‐hospitalization (log rank P = 0.017). No significant difference in adverse events occurred between the groups.ConclusionsThe CaTUS‐guided therapy for AHF resulted in greater decongestion during shorter hospitalization without increased adverse events in this small pilot study and might be associated with a better post‐discharge prognosis.

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Section: Discussionmentioning

confidence: 99%

Focused echocardiography and lung ultrasound protocol for guiding treatment in acute heart failure

et al. 2017

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“…Min Zhou a Wen-Jin Ding b Ying-Wei Chen b Feng Shen a Jun-Yi Zeng vessels and are vulnerable to stimulus [1,2]. In vitro evidence indicates that the endothelium may become activated and turn into a primary source of pro-inflammatory, vasoconstrictive, and pro-thrombotic mediators in response to biomechanical stress [1][2][3].…”

Section: Expression Changes Of Long Noncoding Rna In the Process Of Ementioning

confidence: 99%

“…In vitro evidence indicates that the endothelium may become activated and turn into a primary source of pro-inflammatory, vasoconstrictive, and pro-thrombotic mediators in response to biomechanical stress [1][2][3]. Endothelial cell activation is involved in various pathogenesis of various diseases, such as heart failure and renal failure [4][5][6].…”

Section: Expression Changes Of Long Noncoding Rna In the Process Of Ementioning

confidence: 99%

“…Endothelial cell activation is involved in various pathogenesis of various diseases, such as heart failure and renal failure [4][5][6]. Inflammation, hemostasis, and other biological and pathological processes are all modulated by the endothelium through transitions between quiescent and activated states that occur in response to environmental stressors [2,[7][8][9]. Thus, discover the underlying molecular mechanism of endothelial cell activation is of critical importance to develop therapies for heart failure and renal failure.…”

Section: Expression Changes Of Long Noncoding Rna In the Process Of Ementioning

confidence: 99%

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Expression Changes of Long Noncoding RNA in the Process of Endothelial Cell Activation

Zhou

Ding

Chen

et al. 2017

Cell Physiol Biochem

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Background: Endothelial cells have been shown to be in response to a variety of local and systemic stimuli, and are able to transition between quiescent and activated states. Endothelial cell activation is critical for the pathogenesis of various cardiovascular diseases. However, the expression changes of long non-coding RNAs (lncRNAs) are still unknown in the process of endothelial cell activation. Thus, this study was aimed to investigate expression changes of lncRNA before and after endothelial cell activation. Materials and Methods: In an experimental model of peripheral venous congestion, endothelial cells were activated and analyzed with Affymetrix HG-U133 plus2.0 microarray. We analyzed these microarray data and reannotated the microarray probes for lncRNA. Results: According to the definition of absolute fold change>2 and p value <0.05, 27 differentially expressed lncRNAs were identified and only 1 lncRNA transcript, ENST00000509256 was down-regualted. Co-expression network of lncRNA and mRNA were constructed to predict function of the dysregulated lncRNA. Gene set enrichment analyses suggested that these ENST00000509256 was associated with many important functions, such as cell-cell signaling and regulation of cell differentiation. Conclusion: Many lncRNAs are dysregulated upon endothelial cell activation and further experiments are needed to identify the potential biological functions of these lncRNAs.

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“…Once considered merely a marker of impaired water and solute excretion, recent data have identified congestion as a pro-oxidant and pro-inflammatory stimulus with consequent adverse effects such as endothelial activation [1]. Specifically in HF population, congestion has been recognized as a potent ominous prognostic factor, outperforming a number of established risk factors such as renal dysfunction [2].…”

Section: Introductionmentioning

confidence: 99%

Customization of Peritoneal Dialysis in Cardiorenal Syndrome by Optimization of Sodium Extraction

2019

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Background: Peritoneal dialysis (PD) has emerged as a mechanistically relevant therapeutic option for patients with heart failure (HF), volume overload, and varying degrees of renal dysfunction (i.e., chronic cardiorenal syndrome). Congestion has been identified as a potent ominous prognostic factor in this patient population, outperforming a number of established risk factors. As such, excess fluid removal is recognized as a relevant therapeutic target in this setting. Methods: Accumulating evidence points to the importance of sodium removal as part of any decongestive strategy because extraction of sodium-free water has little or no impact on the outcomes of these patients. Hence, optimization of sodium removal by PD should be the primary focus in the setting of HF and cardiorenal syndrome, especially if PD is started when the patient still has adequate residual renal function for clearance of waste products. Results: Herein, we provide an overview of approaches that can tailor PD treatment to the patients’ characteristics and clinical needs (e.g., choice of PD modality) to fully exploit its decongestive properties. Other methods that could prove helpful in the future will also be briefly discussed. Conclusion: While these strategies could help with efficient sodium extraction and volume optimization, future studies are needed to evaluate their impact on the outcomes of this specific patient population.

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Venous Congestion, Endothelial and Neurohormonal Activation in Acute Decompensated Heart Failure: Cause or Effect?

Cited by 49 publications

References 74 publications

Focused echocardiography and lung ultrasound protocol for guiding treatment in acute heart failure

Focused echocardiography and lung ultrasound protocol for guiding treatment in acute heart failure

Expression Changes of Long Noncoding RNA in the Process of Endothelial Cell Activation

Customization of Peritoneal Dialysis in Cardiorenal Syndrome by Optimization of Sodium Extraction

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