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[Pathophysiology of congestive heart failure]
1Dipartimento Clinico Sperimentale di Medicina e Farmacologia, Sezione di Cardiologia, Università degli Studi, Messina, Italy.
Insights
Congestive heart failure (CHF) is increasingly understood as a neurohormonal disease. Targeting this neuroendocrine activation is key to reducing mortality in CHF patients.
Area of Science:
- Cardiology
- Endocrinology
- Immunology
Context:
- Congestive heart failure (CHF) pathophysiology has evolved significantly over the past 20 years.
- CHF is now recognized as a complex neurohormonal disease, not solely a cardiocirculatory issue.
- Abnormal neuroendocrine activation precedes clinical heart failure and drives disease progression.
Purpose:
- To analyze the role of neuroendocrine activation in the pathophysiology of congestive heart failure.
- To highlight the prognostic value of circulating neurohormonal factors in CHF.
- To discuss the impact of cytokines and apoptosis on CHF progression.
Summary:
- Neurohormonal activation plays a critical role in the progression of congestive heart failure.
- Elevated levels of certain neurohormonal factors are associated with a negative prognosis in CHF patients.
- Immunological factors like cytokines and apoptosis also contribute negatively to CHF pathophysiology.
Impact:
- Understanding neurohormonal mechanisms is crucial for developing effective CHF therapies.
- Therapeutic strategies targeting neurohormonal imbalances offer the most promising approach to decrease CHF mortality.
- This review synthesizes current knowledge on neuroendocrine activation in CHF pathophysiology.
Abstract:
Pathophysiology of congestive heart failure (CHF) has undergone a remarkable evolution during the last two decades. CHF is now regarded especially as a neurohormonal disease and not only as a cardiocirculatory impairment. Many studies have emphasized that an abnormal neuroendocrine activation precedes the development of clinically recognized heart failure and plays an important pathogenetic role in progression of this disease. In patients with CHF, moreover, circulating levels of some neurohormonal factors have an independent negative prognostic value. More recently immunological and molecular biology studies have also demonstrated the negative effects exerted by some cytokines and by apoptosis. Correction of neurohormonal disorder is the rationale of therapeutical approach to patients with CHF and appears the only way to significantly decrease mortality. In this review the role of neuroendocrine activation in the pathophysiology of CHF is analyzed.