Pathophysiology of Fluid Retention in Heart Failure

Author(s):  
Erin Chaney ◽  
Andrew Shaw
2020 ◽  
Vol 19 (5) ◽  
pp. 2402
Author(s):  
V. V. Kirillova ◽  
L. A. Sokolova ◽  
A. A. Garganeyeva ◽  
V. N. Meshchaninov ◽  
R. E. Batalov

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Katsuomi IWAKURA ◽  
Toshinari Onishi ◽  
Koichi Inoue ◽  
Masato Okada ◽  
Yasushi Koyama ◽  
...  

Introduction: Diabetes is observed in about third of patients with heart failure with preserved ejection fraction (HFpEF), and it is not well elucidated how it would affect the clinical conditions of HFpEF. We investigated the physical and echocardiographic characteristics of diabetes patients in a large-scale, registration study of HFpEF. Methods: We analyzed clinical and echocardiography data obtained at admission and just before hospital discharge in the PURSUIT-HFpEF (Prospective, Multicenter, Observational Study of Patients with Heart Failure with Preserved Ejection Fraction), which is a multicenter registration study of patients who were hospitalized for HFpEF. Results: We enrolled 862 patients who were hospitalized for HFpEF between June, 2016 and December, 2019 (Age 81±9 years, male gender 44.5%) for the present study. Diabetes was observed in 287 patients (33.3%), and their age was higher (82±8 years vs. 80±9 years, p=0.003) and body mass index before discharge was larger (23.2±4.7 kg/m2 vs. 21.1±4.6 kg/m2, p<0.0001) than those without diabetes. Diabetic patients had higher body weight at admission (63.2±14.9 kg vs. 55.9±13.4 kg, p<0.0001) and before discharge (56.8±13.3 vs. 50.7±12.1 kg, p<0.0001) than non-diabetic patients. Reduction of body weight during hospital stay was higher in diabetic patients (6.4±4.5 kg) than in non-diabetic patients (5.2±4.0 kg) even after correction of body weight discharge or estimated GFR (p<0.001 by ANCOVA). Body weight reduction was significantly associated with HbA1c (p=0.01). There was no difference in use of intravenous diuretics (69.3% vs. 66.6%, p=0.44) and in hospital stay (21.4±15.3 days vs. 19.9±13.7 days, p=0.14) between diabetic- and non-diabetic patients. Whereas no differences were observed in echocardiographic parameters at admission and before discharge between two arms, the diabetic arm showed significantly higher reduction in septal E/e’ ratio during hospital stay (19.0±8.7 to 17.1±7.6) than non-diabetic arm (16.6±8.3 to 16.4±8.2)(p=0.01 by repeated measure ANOVA). Conclusions: The present study implied that diabetic patients with HFpEF have more fluid retention before hospitalization than non-diabetic ones, which could affect the changes in diastolic pressure.


ESC CardioMed ◽  
2018 ◽  
pp. 1781-1787
Author(s):  
Perry Elliott

Heart failure refers to a state in which the cardiac output, no longer compensated by endogenous mechanisms, fails to meet the metabolic demands of the body. Clinically, it is defined by symptoms of breathlessness, fatigue, fluid retention, and a cardiac structural or functional abnormality. Most cases of heart failure are caused by coronary artery disease, hypertension, diabetes, and valvular heart disease, but the risk of heart failure also depends on genetic predisposition for the causative disorder as well as genetic variation that modulates the maladaptive pathophysiological response to pathophysiological stressors and the response to therapy. In a small, but almost certainly underdiagnosed proportion of cases, heart failure is caused by Mendelian genetic disorders of heart muscle (cardiomyopathies) that are mostly inherited as autosomal dominant traits characterized by locus and allelic heterogeneity and highly variable clinical expression. This chapter briefly reviews the clinical approach to the diagnosis of genetic disorders that cause heart failure and the role of genetic testing in everyday practice.


2000 ◽  
Vol 320 (1) ◽  
pp. 72-74 ◽  
Author(s):  
Roberto Manfredini ◽  
Ricci Luciano ◽  
Giganti Melchiore ◽  
Olga La Cecilia ◽  
Héléne Kuwornu Afi ◽  
...  

Author(s):  
Barry L. Karon ◽  
Naveen L. Pereira

Heart failure is a clinical syndrome characterized by the inability of the heart to maintain adequate cardiac output to meet the metabolic demands of the body while still maintaining normal or near-normal ventricular filling pressures. Heart failure may be present at rest, but often it is present only during exertion as a result of the dynamic nature of cardiac demands. For correct treatment of heart failure, the mechanism, underlying cause, and any reversible precipitating factors must be identified. Typical manifestations of heart failure are dyspnea and fatigue that limit activity tolerance and fluid retention leading to pulmonary or peripheral edema. The most recent proposed categorization divided the cardiomyopathies into primary and secondary cardiomyopathies, and the primary disorders are further subdivided as genetic, acquired, or mixed. Although this proposal takes into account our progressive understanding of this heterogeneous group of disorders, the previous phenotypic classification of dilated, hypertrophic, and restrictive diseases still provides utility in day-to-day understanding and management of these disorders.


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