scholarly journals Vasodilatory Responses of Renal Interlobular Arteries to Epoxyeicosatrienoic Acids Analog Are Not Enhanced in Ren-2 Transgenic Hypertensive Rats: Evidence Against a Role of Direct Vascular Effects of Epoxyeicosatrienoic Acids in Progression of Experimental Heart Failure

2017 ◽  
pp. 29-39 ◽  
Author(s):  
A. SPORKOVÁ ◽  
Z. HUSKOVÁ ◽  
P. ŠKAROUPKOVÁ ◽  
N. RAMI REDDY ◽  
J. R. FALCK ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Epoxyeicosatrienoic Acids ◽  
Sprague Dawley ◽  
Resistance Arteries ◽  
Vascular Effects ◽  
Beneficial Effects ◽  
Function Impairment

Pathophysiological mechanisms underlying the development of renal dysfunction and progression of congestive heart failure (CHF) remain poorly understood. Recent studies have revealed striking differences in the role of epoxyeicosatrienoic acids (EETs), active products of cytochrome P-450-dependent epoxygenase pathway of arachidonic acid, in the progression of aorto-caval fistula (ACF)-induced CHF between hypertensive Ren-2 renin transgenic rats (TGR) and transgene-negative normotensive Hannover Sprague-Dawley (HanSD) controls. Both ACF TGR and ACF HanSD strains exhibited marked intrarenal EETs deficiency and impairment of renal function, and in both strains chronic pharmacologic inhibition of soluble epoxide hydrolase (sEH) (which normally degrades EETs) normalized EETs levels. However, the treatment improved the survival rate and attenuated renal function impairment in ACF TGR only. Here we aimed to establish if the reported improved renal function and attenuation of progression of CHF in ACF TGR observed after sEH blockade depends on increased vasodilatory responsiveness of renal resistance arteries to EETs. Therefore, we examined the responses of interlobar arteries from kidneys of ACF TGR and ACF HanSD rats to EET-A, a new stable 14,15-EET analog. We found that the arteries from ACF HanSD kidneys rats exhibited greater vasodilator responses when compared to the ACF TGR arteries. Hence, reduced renal vasodilatory responsiveness cannot be responsible for the lack of beneficial effects of chronic sEH inhibition on the development of renal dysfunction and progression of CHF in ACF HanSD rats.

scholarly journals Extracorporeal Ultrafiltration for Acute Heart Failure: Lost Battle or Lasting Opportunity?

2016 ◽  
Vol 43 (1-3) ◽  
pp. 1-10 ◽  
Author(s):  
Abhilash Koratala ◽  
Amir Kazory
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Decompensated Heart Failure ◽  
Cardiorenal Syndrome ◽  
Prognostic Impact ◽  
Efficacy And Safety ◽  
Fluid Removal ◽  
Beneficial Effects ◽  
Sodium Removal

The negative prognostic impact of congestion and worsening renal function in patients with decompensated heart failure (HF) has been widely recognized. As diuretics are thought to provide suboptimal results and are associated with a number of adverse effects, a number of diuretic-sparing therapeutic strategies have been explored. Extracorporeal ultrafiltration (UF) represents an intriguing option that presumably lacks many of the untoward effects of diuretic-based regimens while portending several advantages. However, conflicting data have recently emerged in relation to some of its previously proposed beneficial effects possibly due to counterbalance of the underexplored mechanisms. Herein, the existing literature on the role of UF therapy for management of acute decompensated HF is briefly reviewed with special emphasis on its impact on surrogates of efficacy and safety such as excess fluid removal and renal function. A number of topics relevant to cardiorenal syndrome such as congestion and sodium removal are also discussed.

scholarly journals Impact of SGLT2 Inhibitors on Heart Failure: From Pathophysiology to Clinical Effects

2021 ◽  
Vol 22 (11) ◽  
pp. 5863
Author(s):  
Giuseppe Palmiero ◽  
Arturo Cesaro ◽  
Erica Vetrano ◽  
Pia Clara Pafundi ◽  
Raffaele Galiero ◽  
...  
Keyword(s):  
Heart Failure ◽  
Glucose Transporter ◽  
The Elderly ◽  
Intracellular Sodium ◽  
Clinical Effects ◽  
Glucose Lowering ◽  
Beneficial Effects ◽  
Glucose Transporter 2 ◽  
Function Impairment

Heart failure (HF) affects up to over 20% of patients with type 2 diabetes (T2DM), even more in the elderly. Although, in T2DM, both hyperglycemia and the proinflammatory status induced by insulin resistance are crucial in cardiac function impairment, SGLT2i cardioprotective mechanisms against HF are several. In particular, these beneficial effects seem attributable to the significant reduction of intracellular sodium levels, well-known to exert a cardioprotective role in the prevention of oxidative stress and consequent cardiomyocyte death. From a molecular perspective, patients’ exposure to gliflozins’ treatment mimics nutrient and oxygen deprivation, with consequent autophagy stimulation. This allows to maintain the cellular homeostasis through different degradative pathways. Thus, since their introduction in the clinical practice, the hypotheses on SGLT2i mechanisms of action have changed: from simple glycosuric drugs, with consequent glucose lowering, erythropoiesis enhancing and ketogenesis stimulating, to intracellular sodium-lowering molecules. This provides their consequent cardioprotective effect, which justifies its significant reduction in CV events, especially in populations at higher risk. Finally, the updated clinical evidence of SGLT2i benefits on HF was summarized. Thus, this review aimed to analyze the cardioprotective mechanisms of sodium glucose transporter 2 inhibitors (SGLT2i) in patients with HF, as well as their clinical impact on cardiovascular events.

Abstract 5700: Worsening Renal Function and Arrhythmic Event in Implantable Cardioverter Defibrillator Patients with Nonischemic Heart Failure

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Atsushi Takahashi ◽  
Tsuyoshi Shiga ◽  
Daigo Yagishita ◽  
Keisuke Futagawa ◽  
Naoki Serizawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Implantable Cardioverter Defibrillator ◽  
Shock Therapy ◽  
Electrical Storm ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
Arrhythmic Event ◽  
Icd Shock

Purpose: Implantable Cardioverter Defibrillator (ICD) prevents sudden cardiac death in high risk patients with heart failure (HF). Worsening renal function (WRF) is associated with mortality in patients with myocardial infarction or HF, but its effect on lethal arrhythmia is unknown. We evaluated the influence of WRF on the occurrence of arrhythmic events in patients with nonischemic HF and ICD. Methods: A total of 286 nonischemic HF patients who underwent ICD implantation between 1990 and 2007 were studied. Estimated Glomerular Filtration Rate (eGFR) was calculated using the Modification of Diet in Renal Disease. Renal dysfunction was defined as eGFR <60mL/min/1.73m 2 and WRF was defined as 15mL/min/1.73m 2 per year. Differences in arrhythmia recurrences according to the eGFR and WRF were compared by Kaplan-Meier survival curves. Results: During a mean follow-up time of 2.2+/−1.0 years, 94 (33%) of 286 patients (mean age; 57+/−15 years, 72% male) experienced appropriate ICD shock therapy. There was a significantly higher cumulative rate of appropriate ICD shock therapy (p<0.05) and electrical storm (p<0.05) in patients with renal dysfunction than others. The patients with renal dysfunction at baseline experience WRF more frequently than other patients (53% vs. 23%, respectively, p<0.01). After correcting for age, sex, left ventricular ejection fraction (LVEF), indication for ICD implantation, and use of beta-blockers in a Cox regression model, WRF was still an independent predictor of the time to first appropriate shock (HR 2.21, 95% CI 1.32–3.69, p<0.05) and electrical storm (HR 2.22, 95% CI 1.19 – 4.13, p<0.05). The result of subgroup analysis of 147 patients with low LVEF (LVEF<35%) indicated that the patients with WRF experienced electrical storms more frequently (p<0.05). Conclusion: WRF is associated with increased rate of arrhythmic event in nonischemic HF patients. Especially, those patients with low LVEF and WRF experience more frequent ICD shocks.

scholarly journals Role of angiotensin II in the altered renal function of congestive heart failure.

1984 ◽  
Vol 55 (5) ◽  
pp. 669-675 ◽  
Author(s):  
I Ichikawa ◽  
J M Pfeffer ◽  
M A Pfeffer ◽  
T H Hostetter ◽  
B M Brenner
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Renal Function ◽  
Angiotensin Ii

P2624Association between renal dysfunction and cardiac sympathetic innervation in patients with heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Marsico ◽  
S Paolillo ◽  
P Gargiulo ◽  
I Esposito ◽  
S Dell'aversana ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Sympathetic Activity ◽  
Nyha Class ◽  
Sympathetic Innervation ◽  
Venous Blood ◽  
Left Ventricular ◽  
Washout Rate ◽  
Cardiac Sympathetic Innervation

Abstract Introduction In heart failure (HF) a strict interaction exists between heart and kidney. Previous studies reported a significant impact of sympathetic overdrive, that causes beta-adrenoceptor desensitization, in both renal and heart failure progression. It can be hypothesized that renal failure might be associated with impaired sympathetic activity assessed directly at the myocardial level in patients affected by HF. Purpose Aim of the present observational study was to assess the relationship between renal dysfunction and cardiac sympathetic innervation in HF patients with mildly and severely reduced ejection fraction (HFrEF and HFmEF). Methods Two-hundred and sixty-three patients (84% males; 66±10.8 years) with mild-to-severe HF (EF 31±6.8%) underwent iodine-123 meta-iodobenzylguanidine (123I-MIBG) myocardial scintigraphy to assess sympathetic innervation, evaluating early and late heart to mediastinum (H/M) ratios and washout rate. All patients also underwent clinical evaluation and venous blood sample collection for the assessment of serum creatinine and consequently the estimation of glomerular filtration rate (eGFR) by EPI formula. Results A direct correlation was found between EPI-eGFR and late H/M (r=0,215; p<0.001) (figure 1), with an inverse correlation between NYHA class and late H/M (r=0,152; p=0.013), and a direct correlation between left ventricular EF and late H/M (r=0,348; p<0.001). These results were not confirmed for early H/M, nor washout rate. Dividing the population in reduced eGFR and normal eGFR (cut-off ≤60 ml/min/1,73m2), a statistical significant reduction of late H/M value was found in patients with reduced eGFR (late H/M = 1,49±0,21) compared with patients with preserved eGFR (late H/M = 1,56±0,26) (p=0.020). In a multivariate model, adjusting eGFR for NYHA class and left ventricular EF, reduced eGFR and left ventricular EF remained significant predictors of reduced late H/M (p=0.006 and p<0.001, respectively). Figure 1. linear regression curve Conclusions Patients with impaired renal function and HF show impaired cardiac sympathetic activity compared to HF patients with preserved renal function, and reduced eGFR estimated by EPI formula is a significant predictor of reduced late H/M evaluated by 123I-MIBG. Thus, in future studies, the combination of these two parameters might provide addictive prognostic information in HF patients.

scholarly journals Impact of renal dysfunction on the management and outcome of acute heart failure: results from the French prospective, multicentre, DeFSSICA survey

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e022776 ◽  
Author(s):  
Dominique Dos Reis ◽  
Laurie Fraticelli ◽  
Adrien Bassand ◽  
Stéphane Manzo-Silberman ◽  
Nicolas Peschanski ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Acute Heart Failure ◽  
Clinical Signs ◽  
Academic Community ◽  
Close Monitoring ◽  
Early Assessment ◽  
Group 2 ◽  
Group 1

ObjectivesCardiorenal syndrome (CRS) is the combination of acute heart failure syndrome (AHF) and renal dysfunction (creatinine clearance (CrCl) ≤60 mL/min). Real-life data were used to compare the management and outcome of AHF with and without renal dysfunction.DesignProspective, multicentre.SettingTwenty-six academic, community and regional hospitals in France.Participants507 patients with AHF were assessed in two groups according to renal function: group 1 (patients with CRS (CrCl ≤60 mL/min): n=335) and group 2 (patients with AHF with normal renal function (CrCl >60 mL/min): n=172).ResultsDifferences were observed (group 1 vs group 2) at admission for the incidence of chronic heart failure (56.42% vs 47.67%), use of furosemide (60.9% vs 52.91%), insulin (15.52% vs 9.3%) and amiodarone (14.33% vs 4.65%); additionally, more patients in group 1 carried a defibrillator (4.78% vs 0%), had ≥2 hospitalisations in the last year (15.52% vs 5.81%) and were under the care of a cardiologist (72.24% vs 61.63%). Clinical signs were broadly similar in each group. Brain-type natriuretic peptide (BNP) and BNP prohormone were higher in group 1 than group 2 (1157.5 vs 534 ng/L and 5120 vs 2513 ng/mL), and more patients in group 1 were positive for troponin (58.2% vs 44.19%), had cardiomegaly (51.04% vs 37.21%) and interstitial opacities (60.3% vs 47.67%). The only difference in emergency treatment was the use of nitrates, (higher in group 1 (21.9% vs 12.21%)). In-hospital mortality and the percentage of patients still hospitalised after 30 days were similar between groups, but the median stay was longer in group 1 (8 days vs 6 days).ConclusionsRenal impairment in AHF should not limit the use of loop diuretics and/or vasodilators, but early assessment of pulmonary congestion and close monitoring of the efficacy of conventional therapies is encouraged to allow rapid and appropriate implementation of alternative therapies if necessary.

P0215EXCESSIVE TISSUE SODIUM STORAGE IN PATIENTS WITH NON-DIALYSIS DEPENDENT CARDIO-RENAL SYNDROME IS COMPARABLE TO HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Sandrine Lemoine ◽  
Fabio Salerno ◽  
Alireza Akbari ◽  
Christopher McIntyre
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Estimated Glomerular Filtration Rate ◽  
Residual Renal Function ◽  
Tissue Concentrations ◽  
Spot Urine ◽  
Dialysis Vintage ◽  
Sodium Storage ◽  
Tissue Sodium

Abstract Background and Aims Both CKD and heart failure (HF) are characterized by a propensity to retain sodium. Renal dysfunction worsens the progression of heart failure and is associated with worse outcomes. This may be a result of synergistic aggravation of sodium retention by the two conditions. We aimed to compare tissue Na storage in skin and muscle between cardiorenal (CR) patients and patients with a range of renal dysfunction, including those requiring hemodialysis (HD). Method Proton and 23Na images of the lower limb were acquired on a 3T MRI. We studied 9 CR patients, 7 matched CKD 2-5 patients (without HF) and 31 established HD patients. Regions of interest including skin and soleus were drawn on images to provide a quantitative sodium measurement and these tissue concentrations compared between groups. Blood samples were drawn at each scan in all patients. Spot urine samples were collected for CR patients. Results For CR patients, mean age was 66 ± 8 years, 78% of male, mean estimated glomerular filtration rate (eGFR) was 52 ± 18 mL/min/1.73m2, urea was 11 ± 6 mmol/L. For HD patients, mean age was 66 ± 8.7 years, 68% of male and mean dialysis vintage was 38 ± 37 months for HD patients. Mean age was 63 ± 8, 71 % of male, eGFR 45 ± 29 mL/min/1.73m2 for CKD patients. CR patients displayed an increased amount of salt in skin (32.5 ± 13 mmol/L) and muscle (26 ±4 mmol/L) with levels significantly higher than that seen in GFR matched controls (without HF) and comparable to HD patients (31 ±12 and 28 ± 6 mmol/L p=0.9 and p=0.3 respectively) without meaningful residual renal function. Conclusion The combination of HF and CKD is associated with intense tissue Na storage; resulting in tissue Na accumulation in CR patients (with reasonably well-preserved renal function) similar to CKD patients requiring HD.

Evidence for the existence of endothelin-B receptor subtypes and their physiological roles in the rat

1996 ◽  
Vol 271 (1) ◽  
pp. R254-R261 ◽  
Author(s):  
M. Gellai ◽  
T. Fletcher ◽  
M. Pullen ◽  
P. Nambi
Keyword(s):  
Radioligand Binding ◽  
Rat Kidney ◽  
Receptor Subtypes ◽  
Sprague Dawley ◽  
Vascular Effects ◽  
Renal Vasoconstriction ◽  
Eta Receptor ◽  
Etb Receptor ◽  
Endothelin B

The physiological roles of endothelin-B (ETB) receptor subtypes in systemic and renal hemodynamics were assessed in conscious Sprague-Dawley rats. Mean arterial pressure, hindlimb flow, and renal blood flow were measured via an implanted catheter and pulsed Doppler flow probes. Bolus intravenous injections of sarafotoxin 6c (S6c), a selective ETB agonist, elicited transient dose-dependent vasodilation, followed by sustained vasoconstriction in the systemic bed, but only vasoconstriction in the renal bed. RES-701-1, a selective ETB antagonist, blocked the dilator and potentiated the constrictor effect; SB-209670, a mixed ET receptor antagonist, attenuated both responses to S6c. In follow-up studies, the role of endogenous ET was assessed by administration of the antagonists alone: RES-701-1, SB-209670, and the ETA-selective antagonist BQ-123. RES-701-1 unmasked a significant systemic and renal vasoconstriction, which was attenuated by SB-209670 but not by BQ-123. SB-209670 and BQ-123 had no effect on basal hemodynamic parameters. Data from radioligand binding experiments showed that RES-701-1 binds with high affinity to the cloned human ETB receptor but poorly to the ETB receptor predominant in the rat kidney. Collectively, the results indicate that 1) the vascular effects of ET in the rat are mediated by two ETB receptor subtypes: an RES-701-1-sensitive subtype, mediating vasodilation, and an RES-701-1-insensitive subtype, mediating vasoconstriction; 2) the predominant role of endogenous ET is vasodilation; and 3) the ETA receptor plays a negligible role in the control of vascular tone in the rat.

Role of KATP Channels in Beneficial Effects of Exercise in Ischemic Heart Failure

2015 ◽  
Vol 47 (12) ◽  
pp. 2504-2512 ◽  
Author(s):  
JASENKA KRALJEVIC ◽  
MORTEN ANDRE HØYDAL ◽  
MARKO LJUBKOVIC ◽  
JOSE BIANCO NASCIMENTO MOREIRA ◽  
KARI JØRGENSEN ◽  
...  
Keyword(s):  
Heart Failure ◽  
Katp Channels ◽  
Ischemic Heart ◽  
Ischemic Heart Failure ◽  
Beneficial Effects

Role of N-Terminal Pro-Brain Natriuretic Peptide and Cystatin C to Estimate Renal Function in Patients With and Without Heart Failure

2009 ◽  
Vol 103 (8) ◽  
pp. 1128-1133 ◽  
Author(s):  
Sven Linzbach ◽  
Azat Samigullin ◽  
Sezayi Yilmaz ◽  
Maria Tsioga ◽  
Andreas M. Zeiher ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Cystatin C
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