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1. Organ dysfunction, injury and failure in acute heart failure: from pathophysiology to diagnosis and management. A review on behalf of the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Author

John Parissis, Marek Banaszewski, Christian Mueller, Petar M. Seferovic, Matthieu Legrand, Andreas Schaefer, Wilfried Mullens, Alain Rudiger, Wolfram Doehner, Andreas J. Flammer, Hadi Skouri, Hans-Peter Brunner-La Rocca, Johan Lassus, Valentin Fuhrmann, Veli-Pekka Harjola, Frank Ruschitzka, Gerasimos Filippatos, Mehmet Yilmaz, Zoltán Papp, Ovidiu Chioncel, Mitja Lainscak, Elke Platz, Josep Masip, Johann Bauersachs, Sean P. Collins, Alexandre Mebazaa, University of Zurich, Harjola, Veli-Pekka, [Harjola, Veli-Pekka] Univ Helsinki, Helsinki Univ Hosp, Emergency Med, Helsinki, Finland -- [Mullens, Wilfried] Ziekenhuis Oost Limburg, Dept Cardiol, Genk, Belgium -- [Mullens, Wilfried] Hasselt Univ, Biomed Res Inst, Fac Med & Life Sci, Diepenbeek, Belgium -- [Banaszewski, Marek] Intens Cardiac Therapy Clin, Inst Cardiol, Warsaw, Poland -- [Bauersachs, Johann -- Schaefer, Andreas] Med Sch Hannover, Dept Cardiol & Angiol, Hannover, Germany -- [Brunner-La Rocca, Hans-Peter] Maastricht Univ, Dept Cardiol, Med Ctr, Maastricht, Netherlands -- [Chioncel, Ovidiu] Univ Med & Pharm Carol Davila, Inst Emergency Cardiovasc Dis, Bucharest, Romania -- [Collins, Sean P.] Vanderbilt Univ, Med Ctr, Dept Emergency Med, Nashville, TN USA -- [Doehner, Wolfram] Ctr Stroke Res, Berlin, Germany -- [Doehner, Wolfram] Charite Med Univ, Dept Cardiol, Berlin, Germany -- [Filippatos, Gerasimos S. -- Parissis, John] Univ Athens, Athens Univ Hosp Attikon, Sch Med, Athens, Greece -- [Flammer, Andreas J. -- Ruschitzka, Frank] Univ Zurich Hosp, Univ Heart Ctr, Zurich, Switzerland -- [Fuhrmann, Valentin] Med Univ Vienna, Div Gastroenterol & Hepatol, Vienna, Austria -- [Fuhrmann, Valentin] Univ Med Ctr Hamburg Eppendorf, Dept Intens Care Med, Hamburg, Germany -- [Lainscak, Mitja] Gen Hosp Murska Sobota, Dept Internal Med, Murska Sobota, Slovenia -- [Lainscak, Mitja] Gen Hosp Murska Sobota, Dept Res & Educ, Murska Sobota, Slovenia -- [Lainscak, Mitja] Univ Ljubljana, Fac Med, Ljubljana, Slovenia -- [Lassus, Johan] Univ Helsinki, Helsinki Univ Hosp, Cardiol, Helsinki, Finland -- [Legrand, Matthieu -- Mebazaa, Alexandre] AP HP, INSERM, U942, Paris, France -- [Legrand, Matthieu -- Mebazaa, Alexandre] INI CRCT, Nancy, France -- [Legrand, Matthieu] Univ Paris Denis Diderot, St Louis Hosp, Dept Anaesthesiol, Crit Care & Burn Unit, Paris, France -- [Masip, Josep] Univ Barcelona, Consorci Sanitari Integral Publ Hlth Consortium, Barcelona, Spain -- [Masip, Josep] Hosp Sanitas CIMA, Dept Cardiol, Barcelona, Spain -- [Mueller, Christian] Univ Hosp Basel, Dept Cardiol, Basel, Switzerland -- [Mueller, Christian] Univ Hosp Basel, CRIB, Basel, Switzerland -- [Papp, Zoltan] Univ Debrecen, Div Clin Physiol, Dept Cardiol, Res Ctr Mol Med,Fac Med, Debrecen, Hungary -- [Platz, Elke] Harvard Med Sch, Brigham & Womens Hosp, Dept Emergency Med, Boston, MA USA -- [Rudiger, Alain] Univ Zurich, Univ Zurich Hosp, Cardiosurg Intens Care Unit, Zurich, Switzerland -- [Seferovic, Petar M.] Univ Belgrade, Dept Internal Med, Sch Med, Belgrade, Serbia -- [Seferovic, Petar M.] Univ Belgrade, Heart Failure Ctr, Med Ctr, Belgrade, Serbia -- [Skouri, Hadi] Amer Univ, Div Cardiol, Dept Internal Med, Beirut Med Ctr, Beirut, Lebanon -- [Yilmaz, Mehmet Birhan] Cumhuriyet Univ, Dept Cardiol, Fac Med, Sivas, Turkey -- [Mebazaa, Alexandre] Univ Paris Diderot, Paris, France -- [Mebazaa, Alexandre] Univ Hosp St Louis Lariboisiere, Dept Anaesthesia & Crit Care, Paris, France, YILMAZ, Mehmet Birhan -- 0000-0002-8169-8628, Chioncel, Ovidiu -- 0000-0002-3197-3628, YILMAZ, MEHMET BIRHAN -- 0000-0002-8169-8628, Mebazaa, Alexandre -- 0000-0001-8715-7753, Rudiger, Alain -- 0000-0001-7943-7624, and Flammer, Andreas -- 0000-0002-1373-0630

Subjects
INTENSIVE-CARE-UNIT, LIVER-FUNCTION TESTS, 030204 cardiovascular system & hematology, law.invention, 0302 clinical medicine, law, 030212 general & internal medicine, Myocardial infarction, Elméleti orvostudományok, Societies, Medical, medicine.diagnostic_test, Cardiogenic shock, Acute kidney injury, Disease Management, EMERGENCY-DEPARTMENT PATIENTS, Orvostudományok, Intensive care unit, 3. Good health, Europe, Acute Disease, Cardiology, 10209 Clinic for Cardiology, medicine.symptom, 3RD UNIVERSAL DEFINITION, Cardiology and Cardiovascular Medicine, Diagnostic Imaging, medicine.medical_specialty, ACUTE MYOCARDIAL-INFARCTION, 10216 Institute of Anesthesiology, ACUTE KIDNEY INJURY, 610 Medicine & health, Heart failure, 2705 Cardiology and Cardiovascular Medicine, Article, 03 medical and health sciences, GELATINASE-ASSOCIATED LIPOCALIN, CARDIOGENIC PULMONARY-EDEMA, Internal medicine, medicine, Humans, Intensive care medicine, business.industry, Organ dysfunction, medicine.disease, WORSENING RENAL-FUNCTION, NATRIURETIC PEPTIDE LEVELS, Multiple organ failure, Venous congestion, Clinical trial, Liver function tests, business
Abstract

WOS: 000405571400002, PubMed ID: 28560717, Organ injury and impairment are commonly observed in patients with acute heart failure (AHF), and congestion is an essential pathophysiological mechanism of impaired organ function. Congestion is the predominant clinical profile in most patients with AHF; a smaller proportion presents with peripheral hypoperfusion or cardiogenic shock. Hypoperfusion further deteriorates organ function. The injury and dysfunction of target organs (i.e. heart, lungs, kidneys, liver, intestine, brain) in the setting of AHF are associated with increased risk for mortality. Improvement in organ function after decongestive therapies has been associated with a lower risk for post-discharge mortality. Thus, the prevention and correction of organ dysfunction represent a therapeutic target of interest in AHF and should be evaluated in clinical trials. Treatment strategies that specifically prevent, reduce or reverse organ dysfunction remain to be identified and evaluated to determine if such interventions impact mortality, morbidity and patient-centred outcomes. This paper reflects current understanding among experts of the presentation and management of organ impairment in AHF and suggests priorities for future research to advance the field., Heart Failure Association of the European Society of Cardiology, This work was supported by the Heart Failure Association of the European Society of Cardiology.

Published
2017

2. Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology

Author

Harjola, V-P, Mebazaa, A, Celutkiene, J, Bettex, D, Bueno, H, Chioncel, O, Crespo-Leiro, MG, Falk, V, Filippatos, G, Gibbs, S, Leite-Moreira, A, Lassus, J, Masip, J, Mueller, C, Mullens, W, Naeije, R, Nordegraaf, AV, Parissis, J, Riley, JP, Ristic, A, Rosano, G, Rudiger, A, Ruschitzka, F, Seferovic, P, Sztrymf, B, Vieillard-Baron, A, Yilmaz, MB, Konstantinides, S, University of Zurich, Harjola, Veli-Pekka, [Harjola, Veli-Pekka] Univ Helsinki, Helsinki Univ Hosp, Dept Emergency Med & Serv, Emergency Med, Helsinki, Finland -- [Mebazaa, Alexandre] Univers Paris Diderot, Sorbonne Paris Cite, Paris, France -- [Mebazaa, Alexandre] AP HP, Inserm U942, Paris, France -- [Mebazaa, Alexandre] Hop Univ St Louis Lariboisiere, AP HP, Dept Anaesthesia & Crit Care, Paris, France -- [Celutkiene, Jelena] Vilnius Univ, Fac Med, Clin Cardiac & Vasc Dis, Vilnius, Lithuania -- [Bettex, Dominique] Univ Zurich Hosp, Inst Anaesthesiol, Zurich, Switzerland -- [Bueno, Hector] Hosp Univ 12 Octubre, CNIC, Madrid, Spain -- [Bueno, Hector] Hosp Univ 12 Octubre, Inst Invest I 12, Madrid, Spain -- [Bueno, Hector] Hosp Univ 12 Octubre, Dept Cardiol, Madrid, Spain -- [Bueno, Hector] Univ Complutense Madrid, E-28040 Madrid, Spain -- [Chioncel, Ovidiu] Univ Med & Pharm Carol Davila, Inst Emergency Cardiovasc Dis, Bucharest, Romania -- [Crespo-Leiro, Maria G.] CHUAC, Complexo Hosp Univ A Coruna, Unidad Insuficiencia Cardiaca Avanzada & Trasplan, La Coruna, Spain -- [Falk, Volkmar] Deutsch Herzzentrum Berlin, Dept Cardiothorac & Vasc Surg, Berlin, Germany -- [Filippatos, Gerasimos] Athens Univ Hosp Attikon, Athens, Greece -- [Gibbs, Simon -- Riley, Jillian P.] Univ London Imperial Coll Sci Technol & Med, London, England -- [Leite-Moreira, Adelino] Univ Porto, Fac Med, Dept Fisiol & Cirurgia Cardiotorac, Rua Campo Alegre 823, P-4100 Oporto, Portugal -- [Lassus, Johan] Univ Helsinki, Helsinki Univ Hosp, Cardiol, Helsinki, Finland -- [Masip, Josep] Univ Barcelona, Hosp St Joan Despi Moises Broggi, Barcelona, Spain -- [Masip, Josep] Univ Barcelona, Hosp Gen Hosp, Barcelona, Spain -- [Mueller, Christian] Univ Basel Hosp, Dept Cardiol, CH-4031 Basel, Switzerland -- [Mueller, Christian] Univ Basel Hosp, CRIB, CH-4031 Basel, Switzerland -- [Mullens, Wilfried] Hasselt Univ, Fac Med & Life Sci, Genk Biomed Res Inst, Dept Cardiol,Ziekenhuis Oost Limburg, Diepenbeek, Belgium -- [Nordegraaf, Anton Vonk] Free Univ Brussels, Dept Phys, Fac Med, 808 Route Lennik, Brussels, Belgium -- [Parissis, John] Vrije Univ Amsterdam, Medisch Centrum, Amsterdam, Netherlands -- [Parissis, John] Attikon Univ Hosp, Athens, Greece -- [Ristic, Arsen] Clin Ctr Serbia, Dept Cardiol, Belgrade, Serbia -- [Ristic, Arsen] Univ Belgrade, Sch Med, Belgrade, Serbia -- [Rosano, Giuseppe] IRCCS San Raffaele Hosp Roma, Rome, Italy -- [Rosano, Giuseppe] St Georges Univ London, Cardiovasc & Cell Sci Inst, London, England -- [Rudiger, Alain] Univ Hosp, Cardiosurg Intens Care Unit, Zurich, Switzerland -- [Ruschitzka, Frank] Univ Heart Ctr Zurich, Dept Cardiol Heart Failure Clin & Transplantat, Zurich, Switzerland -- [Seferovic, Petar] Univ Belgrade, Sch Med, Dept Internal Med, Belgrade, Serbia -- [Seferovic, Petar] Univ Belgrade, Heart Failure Ctr, Med Ctr, Belgrade, Serbia -- [Sztrymf, Benjamin] Hop Univ Paris Sud, AP HP, Hop Antoine Beclere, Reanimat Polyvalente, Clamart, France -- [Vieillard-Baron, Antoine] INSERM U 1018, CESP, UVSQ, Team 5,EpReC Renal & Cardiovasc Epidemiol, Villejuif, France -- [Vieillard-Baron, Antoine] Univ Hosp Ambroise Pare, AP HP, Boulogne, France -- [Yilmaz, Mehmet Birhan] Cumhuriyet Univ, Fac Med, Dept Cardiol, Sivas, Turkey -- [Konstantinides, Stavros] Univ Med Ctr Mainz, CTH, Mainz, Germany -- [Konstantinides, Stavros] Democritus Univ Thrace, Dept Cardiol, Alexandroupolis, Greece, YILMAZ, MEHMET BIRHAN -- 0000-0002-8169-8628, Lamonaca, Palma -- 0000-0003-4891-2255, Celutkiene, Jelena -- 0000-0003-3562-9274, Chioncel, Ovidiu -- 0000-0002-3197-3628, Bueno, Hector -- 0000-0003-0277-7596, YILMAZ, Mehmet Birhan -- 0000-0002-8169-8628, Rudiger, Alain -- 0000-0001-7943-7624, Leite-Moreira, Adelino -- 0000-0001-7808-3596, Mebazaa, Alexandre -- 0000-0001-8715-7753, and Falk, Volkmar -- 0000-0002-7911-8620

Subjects
Pulmonary Circulation, Cardiac & Cardiovascular Systems, INTENSIVE-CARE-UNIT, 10216 Institute of Anesthesiology, Ventricular Dysfunction, Right, RESPIRATORY-DISTRESS-SYNDROME, Heart failure, 610 Medicine & health, TROPONIN-T ASSAY, 1102 Cardiovascular Medicine And Haematology, 2705 Cardiology and Cardiovascular Medicine, ASSIST DEVICE, Humans, cardiovascular diseases, Right ventricular dysfunction, Cardiogenic shock, INFERIOR MYOCARDIAL-INFARCTION, Heart Failure, Science & Technology, Right ventricular function, ACUTE COR-PULMONALE, Cardiovascular System & Hematology, CARDIOVASCULAR-DISEASE, Echocardiography, Intensive care, CARDIOGENIC-SHOCK, Cardiovascular System & Cardiology, cardiovascular system, 10209 Clinic for Cardiology, ARTERIAL-HYPERTENSION, Life Sciences & Biomedicine, TASK-FORCE
Abstract

WOS: 000373160000002, PubMed ID: 26995592, Acute right ventricular (RV) failure is a complex clinical syndrome that results from many causes. Research efforts have disproportionately focused on the failing left ventricle, but recently the need has been recognized to achieve a more comprehensive understanding of RV anatomy, physiology, and pathophysiology, and of management approaches. Right ventricular mechanics and function are altered in the setting of either pressure overload or volume overload. Failure may also result from a primary reduction of myocardial contractility owing to ischaemia, cardiomyopathy, or arrhythmia. Dysfunction leads to impaired RV filling and increased right atrial pressures. As dysfunction progresses to overt RV failure, the RV chamber becomes more spherical and tricuspid regurgitation is aggravated, a cascade leading to increasing venous congestion. Ventricular interdependence results in impaired left ventricular filling, a decrease in left ventricular stroke volume, and ultimately low cardiac output and cardiogenic shock. Identification and treatment of the underlying cause of RV failure, such as acute pulmonary embolism, acute respiratory distress syndrome, acute decompensation of chronic pulmonary hypertension, RV infarction, or arrhythmia, is the primary management strategy. Judicious fluid management, use of inotropes and vasopressors, assist devices, and a strategy focusing on RV protection for mechanical ventilation if required all play a role in the clinical care of these patients. Future research should aim to address the remaining areas of uncertainty which result from the complexity of RV haemodynamics and lack of conclusive evidence regarding RV-specific treatment approaches.

Published
2016

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