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Venous Congestion, Endothelial and Neurohormonal Activation in Acute Decompensated Heart Failure: Cause or Effect?

  • Decompensated Heart Failure (JE Ho, Section Editor)
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Abstract

Venous congestion and endothelial and neurohormonal activation are known to occur in acute decompensated heart failure (ADHF), yet the temporal role of these processes in the pathophysiology of decompensation is not fully understood. Conventional wisdom presumes congestion to be a consequence of worsening cardiovascular function; however, the biomechanically driven effects of venous congestion are biologically plausible contributors to ADHF that remain largely unexplored in vivo. Recent experimental evidence from human models suggests that fluid accumulation and venous congestion are not simply consequences of poor cardiovascular function, but rather are fundamental pro-oxidant, pro-inflammatory, and hemodynamic stimuli that contribute to acute decompensation. The latest advances in the monitoring of volume status using implantable devices allow for the detection of venous congestion before symptoms arise. This may ultimately lead to improved treatment strategies including not only diuretics, but also specific, adjuvant interventions to counteract endothelial and neurohormonal activation during early preclinical decompensation.

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Acknowledgments

This study was supported by the A. L. Mailman Family Foundation, NIH Grant Number HL092144 and NIH Grant Number DE018739.

Compliance with Ethics Guidelines

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Conflict of Interest

Paolo C. Colombo, Amanda C. Doran, Duygu Onat, Ka Yuk Wong, Myra Ahmad, Hani N. Sabbah, and Ryan T. Demmer declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Division of Cardiology, College of Physicians & Surgeons, Department of Medicine, Columbia University, 622 West 168th Street, PH 12-134, New York, NY, 10032, USA

    Paolo C. Colombo & Amanda C. Doran

  2. Division of Cardiology, College of Physicians & Surgeons, Department of Medicine, Columbia University, 630 West 168th Street, P&S 17-401, New York, NY, 10032, USA

    Duygu Onat

  3. Division of Cardiology, College of Physicians & Surgeons, Department of Medicine, Columbia University, 630 West 168th Street, P&S 8-510, New York, NY, 10032, USA

    Ka Yuk Wong & Myra Ahmad

  4. Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Heart and Vascular Institute, 2799 West Grand Boulevard, Detroit, MI, 48202, USA

    Hani N. Sabbah

  5. Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, 7th floor, New York, NY, 10032, USA

    Ryan T. Demmer

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  1. Paolo C. Colombo
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Correspondence to Paolo C. Colombo.

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This article is part of the Topical Collection on Decompensated Heart Failure

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Colombo, P.C., Doran, A.C., Onat, D. et al. Venous Congestion, Endothelial and Neurohormonal Activation in Acute Decompensated Heart Failure: Cause or Effect?. Curr Heart Fail Rep 12, 215–222 (2015). https://doi.org/10.1007/s11897-015-0254-8

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