Cardiorenal syndrome: Pathophysiology as a key to the therapeutic approach in an under‐diagnosed disease

Prastaro, Maria; Nardi, Ermanno; Paolillo, Stefania; Santoro, Ciro; Parlati, Antonio Luca Maria; Gargiulo, Paola; Basile, Christian; Buonocore, Davide; Esposito, Giovanni; Filardi, Pasquale Perrone

doi:10.1002/jcu.23265

Cited by 10 publications

(12 citation statements)

References 96 publications

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“…LUS is an easy, feasible, and fast evaluation method that adds significant value to the base characteristics of patients with heart failure. 6 , 7 The correlation of LUS with eGFR and hemoglobin indicates the ability to select more fragile heart failure patients, like the cardiorenal syndrome phenotype 8 and iron-deficiency phenotype, 9 at higher risk of cardiovascular events. This is further proved by its correlation with 3-month new-onset or worsening dyspnea.…”

Section: Commentsmentioning

confidence: 99%

Lung ultrasound at discharge predicts outcomes in heart failure: a pilot study

Perillo,

Basile,

Fucile

et al. 2024

Journal of Cardiovascular Medicine

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Lung ultrasound (LUS) is a valid tool for the assessment of pulmonary congestion in patients with heart failure. However, whether LUS congestion predicts clinical outcomes in heart failure has yet to be widely validated. We investigated the presence of an association between the grade of residual pulmonary congestion assessed by LUS at hospital discharge and 3-month clinical outcomes in patients with heart failure. Materials and methodsA prospective observational study was conducted on 85 patients who presented with heart failure during hospitalization in the Cardiac Rehabilitation Unit at the Federico II University Hospital of Naples from March 2021 until September 2022. The study was conducted in accordance with the principles of the Declaration of Helsinki. All participants signed the informed consent before participating.LUS was performed at hospital discharge using LUS score as an ultrasound indicator of pulmonary congestion. To calculate the LUS score, both hemithoraxes were topographically divided into six regions, each of which was assigned a score from 0 to 3: 0, 0-3 B-lines; 1, >3 B-lines; 2, confluent B-lines; 3, white lung. 1 Clinical, echocardiographic, and laboratory values were collected at admission and hospital discharge. CKD was defined as an eGFR below 60 ml/min/1.73 m 2 using the CKD-EPI formula.Remote monitoring was performed through dedicated phone calls at 90 days after hospital discharge to evaluate new-onset/worsening dyspnea, cardiovascular rehospitalization, angina, and death from cardiovascular causes. We investigated the relationship between available variables and clinical outcomes using a multivariable logistic regression model with converging backward and forward stepwise selection. Multicollinearity was evaluated using the variance inflation factor. All statistical analyses were performed using R (R Foundation). Two-sided P-value less than 0.05 was considered significant. ResultsBaseline characteristics of the enrolled population are summarized in Table 1. The study population was composed of patients with heart failure, 70.5% recovering from an acute myocardial infarction, 20.0% recovering from an acute heart failure event and 9.5% recovering after a complex elective coronary revascularization. Research LetterÃ Andrea Perillo and Christian Basile share the first authorship.

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Section: Commentsmentioning

confidence: 99%

Lung ultrasound at discharge predicts outcomes in heart failure: a pilot study

Perillo,

Basile,

Fucile

et al. 2024

Journal of Cardiovascular Medicine

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“…Nonetheless, different studies have shown that the incidence of renal failure is independent of blood pressure levels, and it is comparable among HF patients with reduced or preserved left ventricular ejection fraction (LVEF) [ 1 ]. Thus, it is reasonable to think that independently of the hemodynamic alterations, different other mechanisms are potentially involved in the pathophysiology of CRS as suggested by several evidence [ 1 , 30 , 31 , 32 ]. These mechanisms may include endothelial dysfunction; imbalance between ROS production/nitric oxide (NO) bioavailability; persistent RAAS activation; chronic inflammation (with neutrophil migration, leukocyte trafficking, cytokine production, cell apoptosis, chemokine secretion and immunologic imbalance) and the involvement of small noncoding RNAs and epigenetics alterations [ 1 , 27 , 28 , 29 , 30 , 31 , 32 ].…”

Section: Pathophysiology Of Cardiorenal Syndromementioning

confidence: 99%

New Insight in Cardiorenal Syndrome: From Biomarkers to Therapy

Gallo

Lanza

Savoia

2023

IJMS

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Cardiorenal syndrome consists in the coexistence of acute or chronic dysfunction of heart and kidneys resulting in a cascade of feedback mechanisms and causing damage to both organs associated with high morbidity and mortality. In the last few years, different biomarkers have been investigated with the aim to achieve an early and accurate diagnosis of cardiorenal syndrome, to provide a prognostic role and to guide the development of targeted pharmacological and non-pharmacological therapies. In such a context, sodium-glucose cotransporter 2 (SGLT2) inhibitors, recommended as the first-line choice in the management of heart failure, might represent a promising strategy in the management of cardiorenal syndrome due to their efficacy in reducing both cardiac and renal outcomes. In this review, we will discuss the current knowledge on the pathophysiology of cardiorenal syndrome in adults, as well as the utility of biomarkers in cardiac and kidney dysfunction and potential insights into novel therapeutics.

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“…In patients with ADHF, static increases in volume overload lead to elevated central venous pressure (CVP). Elevated CVP is directly related to renal dysfunctionalities ( Prastaro et al, 2022 ). Increased CVP leads to depressed renal venous pressure (RVP), creating a low flow state that reduces the blood flow gradient to kidneys and leading to renal hypoperfusion ( Bock and Gottlieb, 2010 ; Prastaro et al, 2022 ).…”

Section: Pathophysiology Of Acute Crsmentioning

confidence: 99%

“…Elevated CVP is directly related to renal dysfunctionalities ( Prastaro et al, 2022 ). Increased CVP leads to depressed renal venous pressure (RVP), creating a low flow state that reduces the blood flow gradient to kidneys and leading to renal hypoperfusion ( Bock and Gottlieb, 2010 ; Prastaro et al, 2022 ). In patients with reduced cardiac functionalities, the low-flow state occurs due to kidney artery under-filling, resulting in a reduced eGFR (glomerular filtration rate) and reduced renal functionalities, which are associated with higher mortality ( Damman et al, 2009 ; Fu et al, 2021 ).…”

Section: Pathophysiology Of Acute Crsmentioning

confidence: 99%

A comprehensive review of acute cardio-renal syndrome: need for novel biomarkers

et al. 2023

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Cardiorenal syndrome represents a wide-spectrum disorder involving the heart and kidneys as the primary affected organs. India has an increasingly high burden of acute CRS, coinciding with the rise in global statistics. Up to 2022, approximately 46.1% of all cardiorenal patients have been diagnosed with acute CRS in India. Acute CRS involves a sudden deterioration of kidney functionalities, referred to as acute kidney injury (AKI) in acute heart failure patients. The pathophysiology of CRS involves hyperactivation of the sympathetic nervous system (SNS) and the renin-angiotensin-aldosterone system (RAAS) following acute myocardial stress. The pathological phenotype of acute CRS is associated with perturbed inflammatory, cellular, and neurohormonal markers in circulation. These complications increase the risk of mortality in clinically diagnosed acute CRS patients, making it a worldwide healthcare burden. Hence, effective diagnosis and early prevention are crucial to prevent the progression of CRS in AHF patients. Present biomarkers, such as serum creatinine (sCr), cystatin C (CysC), glomerular filtration rate (GFR), blood urea nitrogen (BUN), serum and/or urine neutrophil gelatinase-associated lipocalin (NGAL), B-type natriuretic peptide (BNP), and NT-proBNP, are clinically used to diagnose AKI stages in CRS patients but are limitedly sensitive to the early detection of the pathology. Therefore, the need for protein biomarkers is emerging for early intervention in CRS progression. Here, we summarized the cardio-renal nexus in acute CRS, with an emphasis on the present clinicopathological biomarkers and their limitations. The objective of this review is to highlight the need for novel proteomic biomarkers that will curb the burgeoning concern and direct future research trials.

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Cardiorenal syndrome: Pathophysiology as a key to the therapeutic approach in an under‐diagnosed disease

Cited by 10 publications

References 96 publications

Lung ultrasound at discharge predicts outcomes in heart failure: a pilot study

Lung ultrasound at discharge predicts outcomes in heart failure: a pilot study

New Insight in Cardiorenal Syndrome: From Biomarkers to Therapy

A comprehensive review of acute cardio-renal syndrome: need for novel biomarkers

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