TY - JOUR
T1 - Visceral Congestion in Heart Failure
T2 - Right Ventricular Dysfunction, Splanchnic Hemodynamics, and the Intestinal Microenvironment
AU - Polsinelli, Vincenzo B.
AU - Sinha, Arjun
AU - Shah, Sanjiv J.
N1 - Funding Information:
S.J.S. has received grant support from Actelion, AstraZeneca, Corvia, and Novartis; and consulting fees from Actelion, AstraZeneca, Bayer, Boehringer-Ingelheim, Cardiora, Ironwood, Merck, Novartis, Pfizer, and Sanofi.
PY - 2017/12/1
Y1 - 2017/12/1
N2 - Purpose of Review: Visceral venous congestion of the gut may play a key role in the pathogenesis of right-sided heart failure (HF) and cardiorenal syndromes. Here, we review the role of right ventricular (RV) dysfunction, visceral congestion, splanchnic hemodynamics, and the intestinal microenvironment in the setting of right-sided HF. We review recent literature on this topic, outline possible mechanisms of disease pathogenesis, and discuss potential therapeutics. Recent Findings: There are several mechanisms linking RV–gut interactions via visceral venous congestion which could result in (1) hypoxia and acidosis in enterocytes, which may lead to enhanced sodium–hydrogen exchanger 3 (NHE3) expression with increased sodium and fluid retention; (2) decreased luminal pH in the intestines, which could lead to alteration of the gut microbiome which could increase gut permeability and inflammation; (3) alteration of renal hemodynamics with triggering of the cardiorenal syndrome; and (4) altered phosphate metabolism resulting in increased pulmonary artery stiffening, thereby increasing RV afterload. A wide variety of therapeutic interventions that act on the RV, pulmonary vasculature, intestinal microenvironment, and the kidney could alter these pathways and should be tested in patients with right-sided HF. Summary: The RV–gut axis is an important aspect of HF pathogenesis that deserves more attention. Modulation of the pathways interconnecting the right heart, visceral congestion, and the intestinal microenvironment could be a novel avenue of intervention for right-sided HF.
AB - Purpose of Review: Visceral venous congestion of the gut may play a key role in the pathogenesis of right-sided heart failure (HF) and cardiorenal syndromes. Here, we review the role of right ventricular (RV) dysfunction, visceral congestion, splanchnic hemodynamics, and the intestinal microenvironment in the setting of right-sided HF. We review recent literature on this topic, outline possible mechanisms of disease pathogenesis, and discuss potential therapeutics. Recent Findings: There are several mechanisms linking RV–gut interactions via visceral venous congestion which could result in (1) hypoxia and acidosis in enterocytes, which may lead to enhanced sodium–hydrogen exchanger 3 (NHE3) expression with increased sodium and fluid retention; (2) decreased luminal pH in the intestines, which could lead to alteration of the gut microbiome which could increase gut permeability and inflammation; (3) alteration of renal hemodynamics with triggering of the cardiorenal syndrome; and (4) altered phosphate metabolism resulting in increased pulmonary artery stiffening, thereby increasing RV afterload. A wide variety of therapeutic interventions that act on the RV, pulmonary vasculature, intestinal microenvironment, and the kidney could alter these pathways and should be tested in patients with right-sided HF. Summary: The RV–gut axis is an important aspect of HF pathogenesis that deserves more attention. Modulation of the pathways interconnecting the right heart, visceral congestion, and the intestinal microenvironment could be a novel avenue of intervention for right-sided HF.
KW - Heart failure
KW - Intestine
KW - Microbiome
KW - Right ventricle
KW - Sodium–hydrogen exchanger 3
KW - Venous congestion
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U2 - 10.1007/s11897-017-0370-8
DO - 10.1007/s11897-017-0370-8
M3 - Review article
C2 - 29075956
AN - SCOPUS:85032361750
VL - 14
SP - 519
EP - 528
JO - Current Heart Failure Reports
JF - Current Heart Failure Reports
SN - 1546-9530
IS - 6
ER -