TY - JOUR
T1 - Prognostic markers in heart failure - Congestion, neurohormones, and the cardiorenal syndrome
AU - Blair, John Edward Abellera
AU - Manuchehry, Amin
AU - Chana, Amar
AU - Rossi, Joseph
AU - Schrier, Robert W.
AU - Burnett, John C.
AU - Gheorghiade, Mihai
PY - 2007/11/27
Y1 - 2007/11/27
N2 - There are several markers of poor prognosis in heart failure (HF). The most established markers of poor prognosis in HF include neurohormonal (NH) imbalance, low ejection fraction (EF), ventricular arrhythmias, intraventricular conduction delays, low functional capacity, low SBP, and renal failure. The relative importance of these factors is unknown, as they have never been studied together. We present a 74-year-old female with nonischemic cardiomyopathy and an EF<20% who over 24 years since diagnosis, never developed clinical or hemodynamic congestion, was never hospitalized for HF, and never required a loop diuretic. She had all of the clinical indicators of poor prognosis in HF except for severe NH imbalance and renal failure, illustrating their importance in HF prognosis. While NH activation in HF is initially an adaptive mechanism, an imbalance of NH effectors causes congestion leading to a vicious cycle of congestion, renal dysfunction, and worsening of HF. The combination of NH activation and renal failure in HF is a vasomotor nephropathy known as the cardiorenal syndrome (CRS) and portends a poor prognosis. Pharmacological disruption of NH pathways early in HF may prevent CRS and, therefore, improve outcomes.
AB - There are several markers of poor prognosis in heart failure (HF). The most established markers of poor prognosis in HF include neurohormonal (NH) imbalance, low ejection fraction (EF), ventricular arrhythmias, intraventricular conduction delays, low functional capacity, low SBP, and renal failure. The relative importance of these factors is unknown, as they have never been studied together. We present a 74-year-old female with nonischemic cardiomyopathy and an EF<20% who over 24 years since diagnosis, never developed clinical or hemodynamic congestion, was never hospitalized for HF, and never required a loop diuretic. She had all of the clinical indicators of poor prognosis in HF except for severe NH imbalance and renal failure, illustrating their importance in HF prognosis. While NH activation in HF is initially an adaptive mechanism, an imbalance of NH effectors causes congestion leading to a vicious cycle of congestion, renal dysfunction, and worsening of HF. The combination of NH activation and renal failure in HF is a vasomotor nephropathy known as the cardiorenal syndrome (CRS) and portends a poor prognosis. Pharmacological disruption of NH pathways early in HF may prevent CRS and, therefore, improve outcomes.
KW - Congestion
KW - Heart failure
KW - Kidney
KW - Natriuretic peptides
KW - New York Heart Association (NYHA)
KW - Norepinephrine
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U2 - 10.1080/17482940701606913
DO - 10.1080/17482940701606913
M3 - Review article
C2 - 17891672
AN - SCOPUS:36348948975
VL - 9
SP - 207
EP - 213
JO - International Journal of Cardiovascular Interventions
JF - International Journal of Cardiovascular Interventions
SN - 1748-2941
IS - 4
ER -