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Systemerkrankung Herzinsuffizienz

Heart failure is a systemic disease

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Die Kardiologie Aims and scope

Zusammenfassung

Die Herzinsuffizienz betrifft ca. 4 % der deutschen Bevölkerung, ist der häufigste Grund für einen stationären Krankenhausaufenthalt und birgt eine hohe Sterblichkeit und Morbidität. Die Prävalenz der Herzinsuffizienz nimmt mit steigendem Lebensalter zu, und ältere Patienten weisen besonders häufig auch Erkrankungen anderer Organsysteme auf, wie chronische Niereninsuffizienz, Anämie, Adipositas und Typ-2-Diabetes mellitus. Die Zahl der Komorbiditäten hat hierbei einen erheblichen Einfluss auf die Prognose. Wir betrachten daher die Herzinsuffizienz nicht mehr nur als eine isolierte Organerkrankung, sondern als eine Systemerkrankung, bei der das Herz in Kommunikation mit anderen Organen steht. Diese Kommunikation wird insbesondere durch neuroendokrine Aktivierung, Inflammation und Metabolismus bewerkstelligt. Während unsere bisherigen Therapien v. a. auf die neuroendokrine Aktivierung abzielten, so sind neuere Ansätze auf Metabolismus und Inflammation ausgerichtet. Die klinischen Ergebnisse solcher Interventionen zeigen, dass hierdurch (je nach Ansatz) nicht nur das Herz, sondern auch die Niere, metabolische und ggf. auch Tumorerkrankungen günstig beeinflusst werden können. Dies verdeutlicht, dass die Behandlung von Patienten mit Herzinsuffizienz ein interdisziplinärer Ansatz ist, bei dem Kardiologen mit anderen Disziplinen der inneren Medizin eng zusammenarbeiten sollten. In der vorliegenden Arbeit fokussieren wir auf das kardiorenal-metabolische System bei Patienten mit Herzinsuffizienz und welchen Einfluss therapeutische Interventionen in diesem Bereich haben.

Abstract

Heart failure affects approximately 4% of the German population, is the most common reason for hospitalization and is associated with a high morbidity and mortality. The prevalence increases with age, and older patients also frequently have diseases of other organ systems, such as chronic kidney disease, anemia, obesity, and type 2 diabetes mellitus. The number of comorbidities has a significant impact on the prognosis. Therefore, heart failure is no longer regarded as an isolated organ disease but as a systemic disease in which the heart is in communication with other organs. This communication is governed in particular through neuroendocrine activation, inflammation and metabolism. While previous treatments mainly focused on the neuroendocrine activation, more recent approaches target metabolism and inflammation. Depending on the approach, the clinical results of these interventions show that not only the heart, but also the kidneys, metabolic and possibly also tumor diseases can be favorably influenced. This illustrates that the treatment of heart failure is an interdisciplinary approach, in which cardiologists should work closely with other disciplines of internal medicine. The present review focuses on the cardiorenal metabolic system in patients with heart failure, and how therapeutic interventions targeting this system impact the generation and course heart failure.

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Authors and Affiliations

  1. Medizinische Klinik 1, Universitätsklinikum Würzburg, Würzburg, Deutschland

    Martin Christa &  Christoph Maack

  2. Department Translationale Forschung, Deutsches Zentrum für Herzinsuffizienz, Universitätsklinikum Würzburg, Am Schwarzenberg 15, Haus A15, 97078, Würzburg, Deutschland

    Christoph Maack

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M. Christa: Vortragshonorar von Pfizer, Weiterbildungs-Grants von Abiomed und Abbott. Alles ohne direkten Bezug zur hier vorliegenden Publikation. C. Maack: Referentenhonorare von Astra, Bayer, Boehringer Ingelheim, BMS, Berlin Chemie, Servier, Novartis, Novo Nordisk, Pfizer. Beratertätigkeiten für Servier, Boehringer Ingelheim, AstraZeneca und Amgen.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Christa, M., Maack, C. Systemerkrankung Herzinsuffizienz. Kardiologie 18, 135–142 (2024). https://doi.org/10.1007/s12181-024-00677-w

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