P4394Diabetes paradox in Tako-Tsubo cardiomyopathy: beneficial effect of diabetes on myocardial edema

Alvarado, Teresa; Cecconi, Alberto; Antuña, Paula; Salamanca, Jorge; Nogales-Romo, María Teresa; Viliani, Dafne; Pozo, Eduardo; Diego, Guillermo; Rojas-González, Antonio; Rivero, Fernando; Muñiz, Susana Hernandez; Olivera, María José; Caballero, Paloma; Jiménez-Borreguero, Luis Jesús; Alfonso, Fernándo

doi:10.1093/eurheartj/ehy563.p4394

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“…In fact, in post-infarct mouse models, stimulating lymphangiogenesis with exogenous VEGF-C or adrenomedullin increases lymph flow, decreases MO, attenuates myocardial inflammation and fibrosis and improves cardiac function. [176][177][178][179][180] Still, this promising therapeutic avenue has been recently questioned by the absent impact of genetic blockade of lymphangiogenesis on cardiac function after experimental myocardial infarction. 181…”

Section: Cardiac Lymphatic Systemmentioning

confidence: 99%

“…176 Myocardial oedema has not been evaluated as an endpoint in HF randomized clinical trials, and the effect of most drugs on myocardial fluid balance is currently unknown. However, pre-clinical evidence supports the beneficial effect of spironolactone 92 and SGLT2 inhibitors 177 by protecting endothelial glycocalyx. Interestingly, these two drug classes were shown to provide clinical benefit across a wide ejection fraction range in HF, [178][179][180][181] supporting a possible role for myocardial fluid balance among their mechanisms of action.…”

Section: Clinical Perspectivementioning

confidence: 99%

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Myocardial oedema: pathophysiological basis and implications for the failing heart

et al. 2022

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Myocardial fluid homeostasis relies on a complex interplay between microvascular filtration, interstitial hydration, cardiomyocyte water uptake and lymphatic removal. Dysregulation of one or more of these mechanisms may result in myocardial oedema. Interstitial and intracellular fluid accumulation disrupts myocardial architecture, intercellular communication, and metabolic pathways, decreasing contractility and increasing myocardial stiffness. The widespread use of cardiac magnetic resonance enabled the identification of myocardial oedema as a clinically relevant imaging finding with prognostic implications in several types of heart failure. Furthermore, growing experimental evidence has contributed to a better understanding of the physical and molecular interactions in the microvascular barrier, myocardial interstitium and lymphatics and how they might be disrupted in heart failure. In this review, we summarize current knowledge on the factors controlling myocardial water balance in the healthy and failing heart and pinpoint the new potential therapeutic avenues.

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