Role of splanchnic circulation in the pathogenesis of heart failure: State-of-the-art review

Hidenori Yaku*, Marat Fudim, Sanjiv J. Shah

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations

Abstract

A hallmark of heart failure (HF), whether it presents itself during rest or periods of physical exertion, is the excessive elevation of intracardiac filling pressures at rest or with exercise. Many mechanisms contribute to the elevated intracardiac filling pressures, and notably, the concept of volume redistribution has gained attention as a cause of the elevated intracardiac filling pressures in patients with HF, particularly HF with preserved ejection fraction, who often present without symptoms at rest, with shortness of breath and fatigue appearing only during exertion. This phenomenon suggests cardiopulmonary system non-compliance and inappropriate volume distribution between the stressed and unstressed blood volume components. A substantial proportion of the intravascular blood volume is in the splanchnic vascular compartment in the abdomen. Preclinical and clinical investigations support the critical role of the sympathetic nervous system in modulating the capacitance and compliance of the splanchnic vascular bed via modulation of the greater splanchnic nerve (GSN). The GSN activation by stressors such as exercise causes excessive splanchnic vasoconstriction, which may contribute to the decompensation of chronic HF via volume redistribution from the splanchnic vascular bed to the central compartment. Accordingly, for example, GSN ablation for volume management has been proposed as a potential therapeutic intervention to increase unstressed blood volume. Here we provide a comprehensive review of the role of splanchnic circulation in the pathogenesis of HF and potential novel treatment options for redistributing blood volume to improve symptoms and prognosis in patients with HF.

Original languageEnglish (US)
Pages (from-to)330-337
Number of pages8
JournalJournal of Cardiology
Volume83
Issue number5
DOIs
StatePublished - May 2024

Funding

H.Y. has received grants from the Uehara Memorial Foundation, the Japanese Heart Failure Society Tsuchiya Foundation, and the Fukuda Foundation for Medical Technology for research activities at Northwestern University. M.F. was supported by the NIH ( 1OT2HL156812–01 ; 1R01HL171305–01 ), and Doris Duke. S.J.S. was supported by grants from the National Heart, Lung, and Blood Institute ( U54 HL160273 , R01 HL107577 , R01 HL127028 , R01 HL140731 , and R01 HL149423 ).

Keywords

  • Congestion
  • Heart failure with preserved ejection fraction
  • Interventional cardiology
  • Splanchnic vasoconstriction
  • Stressed blood volume

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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