Organ dysfunction, injury and failure in acute heart failure: from pathophysiology to diagnosis and management. A review on behalf of the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Abstract

Organ injury and impairment are commonly observed in patients with acute heart failure (AHF), and congestion is an essential pathophysiological mechanism of impaired organ function. Congestion is the predominant clinical profile in most patients with AHF; a smaller proportion presents with peripheral hypoperfusion or cardiogenic shock. Hypoperfusion further deteriorates organ function. The injury and dysfunction of target organs (i.e. heart, lungs, kidneys, liver, intestine, brain) in the setting of AHF are associated with increased risk for mortality. Improvement in organ function after decongestive therapies has been associated with a lower risk for post-discharge mortality. Thus, the prevention and correction of organ dysfunction represent a therapeutic target of interest in AHF and should be evaluated in clinical trials. Treatment strategies that specifically prevent, reduce or reverse organ dysfunction remain to be identified and evaluated to determine if such interventions impact mortality, morbidity and patient-centred outcomes. This paper reflects current understanding among experts of the presentation and management of organ impairment in AHF and suggests priorities for future research to advance the field.

Comprehensive in‐hospital monitoring in acute heart failure: applications for clinical practice and future directions for research. A statement from the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

“…Since a single clinical symptom or sign may lack sensitivity or specificity, clinical decisions should be based on comprehensive evaluation of all findings . Congestion in the setting of AHF is also associated with organ dysfunction and poor prognosis . Far fewer patients present with symptoms or clinical signs of hypoperfusion or cardiogenic shock (e.g.…”

“…The initial primary therapeutic objectives in AHF are the control of symptoms and relief of congestion and fluid overload while preventing further organ injury . The ESC guidelines recommend daily assessment of weight and accurate fluid balance charting .…”

Circulating markers of collagen types I, III, and IV in patients with dilated cardiomyopathy: relationships with myocardial collagen expression

“…[5][6][7][8][9] In addition, we and others have recently reported that breakdown peptide of 7S domain of collagen type IV (P4NP 7S), another type of collagen composing the basement membrane in the ECM, was correlated with haemodynamics and had potential prognostic utility in patients with acutely decompensated HF. 12 Injury to those organs may activate pro-fibrotic response, leading to the release of collagen peptides. 12 Injury to those organs may activate pro-fibrotic response, leading to the release of collagen peptides.…”

Highlights in heart failure

“…15, [216][217][218] Multiple factors may contribute to the poor outcomes of the patients after the hospitalization for acute HF, including socioeconomic factors, poor patient support, and poor adherence to prescribed medications. 24, [223][224][225][226][227] Unfortunately, strategies aimed at a better medical treatment of the acute phase, have failed to improve outcomes in major multicentre trials. 222 Other mechanisms are more directly related with congestion and possibly with myocardial, renal, and hepatic injury with persistent organ dysfunction.…”