Role of Volume Redistribution in the Congestion of Heart Failure

Fudim, Marat; Hernandez, Adrian F.; Felker, G. Michael

doi:10.1161/jaha.117.006817

Cited by 133 publications

(132 citation statements)

References 112 publications

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“…94,95 Decreased arterial, and equally if not more importantly venous compliance, are conceptually driven by (i) obesity-mediated neurohormonal and inflammatory activation, and (ii) possibly by pure mechanical properties of the adipose tissue. 96 The splanchnic vascular compartment is the largest reservoir of intravascular blood volume, with the majority of the blood located in the venous system. It has been proposed that inter-compartmental volume redistribution from the abdominal/splanchnic compartment into the central compartment (chest and central vasculature) could be a key determinant of cardiovascular congestion and cause of cardiac decompensation.…”

Section: Vascular Compliance and Splanchnic Couplingmentioning

confidence: 99%

Regional adiposity and heart failure with preserved ejection fraction

Rao

Fudim

Mentz

et al. 2020

European J of Heart Fail

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The role of obesity in the pathogenesis of heart failure (HF), and in particular HF with preserved ejection fraction (HFpEF), has drawn significant attention in recent years. The prevalence of both obesity and HFpEF has increased worldwide over the past decades and when present concomitantly suggests an obese-HFpEF phenotype. Anthropometrics, including body mass index, waist circumference, and waist-to-hip ratio, are associated with incident HFpEF. However, the cardiovascular effects of obesity may actually be driven by the distribution of fat, which can accumulate in the epicardial, visceral, and subcutaneous compartments. Regional fat can be quantified using non-invasive imaging techniques, including computed tomography, magnetic resonance imaging, and dual-energy X-ray absorptiometry. Regional variations in fat accumulation are associated with different HFpEF risk profiles, whereby higher epicardial and visceral fat have a much stronger association with HFpEF risk compared with elevated subcutaneous fat. Thus, regional adiposity may serve a pivotal role in the pathophysiology of HFpEF contributing to decreased cardiopulmonary fitness, impaired left ventricular compliance, upregulation of local and systemic inflammation, promotion of neurohormonal dysregulation, and increased intra-abdominal pressure and vascular congestion. Strategies to reduce total and regional adiposity have shown promise, including intensive exercise, dieting, and bariatric surgery programmes, but few studies have focused on HFpEF-related outcomes among obese. Further understanding the role these variable fat depots play in the progression of HFpEF and HFpEF-related hospitalizations may provide therapeutic targets in treating the obese-HFpEF phenotype.

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Section: Vascular Compliance and Splanchnic Couplingmentioning

confidence: 99%

Regional adiposity and heart failure with preserved ejection fraction

Rao

Fudim

Mentz

et al. 2020

European J of Heart Fail

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“…Возможным объяснением неблагоприятного влияния повышения плотности печени на риск повторных госпитализаций с СН может быть концепция нарушенного внутрисосудистого распределения жидкости, подразумевающая важную роль емкостных сосудов печени в регуляции водного баланса при СН [22]. В условиях ХСН вследствие длительного венозного застоя и стойкой адренергической стимуляции развивается дезадаптация реакции емкостных сосудов, спазм и последующее перераспределение депонирующейся в них жидкости в системный кровоток, что резко увеличива-ОРИГИНАЛЬНЫЕ СТАТЬИ § ет эффективный объем циркулирующей крови и преднагрузку на сердце, тем самым приводя к появлению симптомов декомпенсации [22]. Соответственно, пациенты с высокими значениями плотности печени и, следовательно, с более выраженным застоем органа, характеризуются потенциально большим риском быстрого ухудшения СН.…”

Section: Discussionunclassified

“…Kardiologiia. 2018;58(S10): [20][21][22][23][24][25][26][27][28][29][30][31][32] Summary Objective: There is growing evidence that liver stiffness (LS) in decompensated heart failure (DHF) is related to congestion, however data about its impact on outcomes are limited. The aim of the study was to evaluate associations and long-term prognostic significance of LS measured by transient elastography (TE) in DHF.…”

mentioning

confidence: 99%

Prognostic value of liver stiffness in decompensated heart failure: results of prospective observational transient elastography-based study

Soloveva¹,

Kobalava²,

Villevalde³

et al. 2018

CARDIO

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Прогностическое значение плотности печени при декомпенсации сердечной недостаточности: результаты проспективного наблюдательного исследования, основанные на данных непрямой эластометрии Ключевые слова: декомпенсация сердечной недостаточности, непрямая эластометрия, плотность печени, застойная гепатопатия, прогноз

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“…When the cardiac burden persists even under adequate diuretic therapy for unloading the heart, strategies to further reduce the cardiac burden or enhance cardiac power are required in parallel, such as by using inotropes, controlling blood pressure and heart rate, modulating cardiac re-synchronization, and ultrafiltration [ 47 , 80 ]. Appropriate use of vasodilators or blockade of the RAAS to increase venous capacitance may be an important therapeutic option for reducing the cardiac burden [ 13 , 14 ].…”

Section: Proposal For New Diuretic Classification and Achievement Of mentioning

confidence: 99%

Proposal for New Classification and Practical Use of Diuretics According to Their Effects on the Serum Chloride Concentration: Rationale Based on the “Chloride Theory”

Kataoka

2020

Cardiol Ther

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Currently, diuretic therapy for heart failure (HF) pathophysiology is primarily focused on the sodium and water balance. Over the last several years, however, chloride (Cl) has been recognized to have an important role in HF pathophysiology, as both a prognostic marker and a possible central factor regulating the body fluid status. I recently proposed a unifying hypothesis for HF pathophysiology, called the “chloride theory”, during HF worsening and recovery, as follows. Chloride is the key electrolyte for regulating both reabsorption of tubular electrolytes and water in the kidney through the renin–angiotensin–aldosterone system and distributing body fluid in each compartment of the body. As changes between the serum Cl concentration and plasma volume are intimately associated with worsening HF and its recovery after decongestive therapy, modulation of the serum Cl concentration by careful selection and combination of various diuretics and their doses could become an attractive therapeutic option for HF. In this review, I will propose a new classification and practical use of diuretics according to their effects on the serum Cl concentration. Diuretic use according to this classification is expected to be a useful strategy for the treatment of patients with HF.

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Role of Volume Redistribution in the Congestion of Heart Failure

Cited by 133 publications

References 112 publications

Regional adiposity and heart failure with preserved ejection fraction

Regional adiposity and heart failure with preserved ejection fraction

Prognostic value of liver stiffness in decompensated heart failure: results of prospective observational transient elastography-based study

Proposal for New Classification and Practical Use of Diuretics According to Their Effects on the Serum Chloride Concentration: Rationale Based on the “Chloride Theory”

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