Lung-heart interaction as a substrate for the improvement in exercise capacity after body fluid volume depletion in moderate congestive heart failure

Agostoni, Piergiuseppe; Marenzi, Giancarlo; Sganzerla, Paolo; Assanelli, Emilio; Guazzi, Marco; Perego, Giovanni Battista; Lauri, Gianfranco; Doria, Elisabetta; Pepi, Mauro; Guazzi, Maurizio D.

doi:10.1016/s0002-9149(99)80229-x

Cited by 66 publications

(55 citation statements)

References 20 publications

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“…23,27-31 UF improves cardiac filling pressures, 28,29,[32][33][34][35] symptoms, exercise capacity, 32,33,36,37 and renal perfusion. 38 Serum sodium also improves…”

Section: Clinical Experience With Uf For Hfmentioning

confidence: 98%

“…with UF, 23,27,29,39,40 though one study demonstrated a slight decrease, 41 while other electrolytes remain stable. 28,38,42,43 UF also has a favorable effect on pulmonary function, ventilation efficiency, water content in the lungs, 33,36,37,44 plasma neurohormones including norepinephrine, renin and aldosterone, 38,42,45 and diuretic responsiveness 29,39,42,45,46 ( Table III).…”

Section: Clinical Experience With Uf For Hfmentioning

confidence: 99%

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Ultrafiltration for Congestive Heart Failure

Thorsgard¹,

Bart²

2009

Congestive Heart Failure

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Relief of congestive symptoms is a primary goal in treating heart failure. Ultrafiltration is a tool that can be used to safely remove sodium and water from whole blood at a controlled rate. Ultrafiltration decreases symptoms, relieves congestion, and improves hemodynamics, neurohormonal balance, and exercise capacity. This article describes the importance of congestion as a therapeutic target in heart failure and outlines the development of ultrafiltration as a treatment to address this important physiologic state.

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“…23,27-31 UF improves cardiac filling pressures, 28,29,[32][33][34][35] symptoms, exercise capacity, 32,33,36,37 and renal perfusion. 38 Serum sodium also improves…”

Section: Clinical Experience With Uf For Hfmentioning

confidence: 98%

Section: Clinical Experience With Uf For Hfmentioning

confidence: 99%

Ultrafiltration for Congestive Heart Failure

Thorsgard¹,

Bart²

2009

Congestive Heart Failure

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“…UF therapy was initially explored in a series of interesting studies in Europe trying to elucidate its underlying mechanisms of action in the setting of ADHF, while simultaneously exploring its cardiorespiratory effects (11)(12)(13). Because exacerbation in neurohormonal activity is considered a key pathway in development, progression, and prognosis of HF, it was the focus of several UF studies.…”

Section: Mechanistic Considerationsmentioning

confidence: 99%

Ultrafiltration Therapy for Heart Failure: Balancing Likely Benefits against Possible Risks

Kazory

2016

CJASN

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Heart failure remains a major public health concern because of its high prevalence, morbidity, mortality, and financial burden. The poor clinical outcomes associated with acute decompensated heart failure, suboptimal efficacy and safety profile of conventional treatment regimens, and unsatisfactory experiences with the newer classes of pharmacologic therapy underlie the interest in the use of extracorporeal isolated ultrafiltration in this setting. In this article, selected mechanistic aspects of ultrafiltration therapy are briefly reviewed followed by a critical overview of the largest trials in this field. I will discuss the clinical relevance of renal dysfunction and decongestion as two commonly used end points of safety and efficacy in the ultrafiltration trials, with emphasis on the emerging pertinent notions that could challenge our conventional thinking. Finally, a number of practical recommendations (e.g., customization of ultrafiltration rates) are provided for ultrafiltration therapy in the setting of acute decompensated heart failure. Because of a paucity of evidence, universally accepted consensus guidelines cannot yet be generated. As such, when considering ultrafiltration therapy for acute decompensated heart failure, the likely benefits should be carefully balanced against the potential risks for an individual patient. A conceivable implication of the ultrafiltration trials is that collaborative heart failure programs benefiting from nephrology expertise and resources could improve the outcomes and reduce the cost.

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“…32 In contrast to the adverse physiological consequences of loop diuretics, numerous studies have demonstrated favorable responses to ultrafiltration. Such studies have shown that removal of [33][34][35][36][37][38][39][40][41][42][43][44][45][46] The evidence base supporting the use of ultrafiltration is superior to that for loop diuretics. There are 5 randomized controlled trials of ultrafiltration in patients with heart failure.…”

Section: Ultrafiltration Is the Preferred Initialmentioning

confidence: 99%

Treatment of Congestion in Congestive Heart Failure: Ultrafiltration Is the Only Rational Initial Treatment of Volume Overload in Decompensated Heart Failure

Bart

2009

Circ: Heart Failure

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Lung-heart interaction as a substrate for the improvement in exercise capacity after body fluid volume depletion in moderate congestive heart failure

Cited by 66 publications

References 20 publications

Ultrafiltration for Congestive Heart Failure

Ultrafiltration for Congestive Heart Failure

Ultrafiltration Therapy for Heart Failure: Balancing Likely Benefits against Possible Risks

Treatment of Congestion in Congestive Heart Failure: Ultrafiltration Is the Only Rational Initial Treatment of Volume Overload in Decompensated Heart Failure

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