Why We Fail at Heart Failure: Lymphatic Insufficiency Is Disregarded

Area of Science:

• Cardiology
• Physiology

Background:

• The current definition of heart failure may be too restrictive, potentially hindering research into crucial compensatory mechanisms and related conditions.
• Existing heart failure treatments offer only modest improvements in absolute mortality, highlighting the need for novel therapeutic approaches.

Purpose of the Study:

• To evaluate the adequacy of the current heart failure definition in encompassing all relevant pathophysiological aspects.
• To propose an expanded definition of heart failure that incorporates compensatory mechanisms and lymphatic function.
• To identify potential new therapeutic targets for congestive heart failure.

Main Methods:

• Review of absolute mortality data for heart failure drugs and devices.
• Analysis of the significant mortality associated with common heart failure comorbidities.
• Assessment of the role of lymphatic function in cardiac compensation and comorbidity.

Main Results:

• Current heart failure therapies provide only modest survival benefits.
• Numerous comorbidities, including renal insufficiency, arrhythmias, and diabetes, significantly contribute to mortality in heart failure patients.
• Lymphatic function appears integral to both short-term and long-term cardiac compensation and influences multiple comorbidities.

Conclusions:

• The definition of heart failure should be broadened to include right and left ventricular dysfunction, failure of peripheral compensatory mechanisms, and the role of lymphatic function.
• Further research into lymphatic anatomy, fluid management, and immune modulation is warranted.
• An updated definition and focus on lymphatic function may pave the way for improved therapies for congestive heart failure.