Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/15509
Title: Abdominal Contributions to Cardiorenal Dysfunction in Congestive Heart Failure
Authors: VERBRUGGE, Frederik 
DUPONT, Matthias 
STEELS, Paul 
GRIETEN, Lars 
Malbrain, Manu L. N.
Tang, W. H. Wilson
MULLENS, Wilfried 
Issue Date: 2013
Publisher: ELSEVIER SCIENCE INC
Source: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 62 (6), p. 485-495
Abstract: Current pathophysiological models of congestive heart failure unsatisfactorily explain the detrimental link between congestion and cardiorenal function. Abdominal congestion (i.e., splanchnic venous and interstitial congestion) manifests in a substantial number of patients with advanced congestive heart failure, yet is poorly defined. Compromised capacitance function of the splanchnic vasculature and deficient abdominal lymph flow resulting in interstitial edema might both be implied in the occurrence of increased cardiac filling pressures and renal dysfunction. Indeed, increased intra-abdominal pressure, as an extreme marker of abdominal congestion, is correlated with renal dysfunction in advanced congestive heart failure. Intriguing findings provide preliminary evidence that alterations in the liver and spleen contribute to systemic congestion in heart failure. Finally, gut-derived hormones might influence sodium homeostasis, whereas entrance of bowel toxins into the circulatory system, as a result of impaired intestinal barrier function secondary to congestion, might further depress cardiac as well as renal function. Those toxins are mainly produced by micro-organisms in the gut lumen, with presumably important alterations in advanced heart failure, especially when renal function is depressed. Therefore, in this state-of-the-art review, we explore the crosstalk between the abdomen, heart, and kidneys in congestive heart failure. This might offer new diagnostic opportunities as well as treatment strategies to achieve decongestion in heart failure, especially when abdominal congestion is present. Among those currently under investigation are paracentesis, ultrafiltration, peritoneal dialysis, oral sodium binders, vasodilator therapy, renal sympathetic denervation and agents targeting the gut microbiota. (J Am Coll Cardiol 2013;62:485-95) (C) 2013 by the American College of Cardiology Foundation
Notes: [Verbrugge, Frederik H.; Dupont, Matthias; Grieten, Lars; Mullens, Wilfried] Ziekenhuis Oost Limburg, Dept Cardiol, B-3600 Genk, Belgium. [Verbrugge, Frederik H.] Hasselt Univ, Doctoral Sch Med & Life Sci, Diepenbeek, Belgium. [Steels, Paul; Grieten, Lars; Mullens, Wilfried] Hasselt Univ, Fac Med & Life Sci, Biomed Res Inst, Diepenbeek, Belgium. [Malbrain, Manu] Ziekenhuis Netwerk Antwerpen, Intens Care & High Care Burn Unit, Antwerp, Belgium. [Tang, W. H. Wilson] Cleveland Clin, Dept Cardiovasc Med, Inst Heart & Vasc, Cleveland, OH 44106 USA.
Keywords: congestive heart failure; gut; microcirculation; splanchnic circulation;Cardiac & Cardiovascular Systems
Document URI: http://hdl.handle.net/1942/15509
ISSN: 0735-1097
e-ISSN: 1558-3597
DOI: 10.1016/j.jacc.2013.04.070
ISI #: 000322524300002
Category: A1
Type: Journal Contribution
Appears in Collections:Research publications

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