The Early Intertwining of the Heart and the Kidney Through an Impaired Natriuretic Response to Acute Volume Expansion

Abstract

An estimated 20 million Americans may have heart failure without overt symptoms (stage B and early stage C), yet this syndrome remains poorly understood, and therapeutic options are largely limited to lifestyle and risk factor modifications. Although therapy with neurohormonal blockers should be considered for these patients, unless contraindicated, this recommendation is predominantly extrapolated from studies with systolic heart failure patients having minimal signs and symptoms. Therapies for isolated diastolic dysfunction are lacking, even though nearly 50% of heart failure is attributed to impaired diastolic rather than impaired systolic heart function. Understanding the pathophysiology of these pre-clinical stages of the disease is crucial, as treatment success is often considered the relief or prevention of systemic (venous) congestion.