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Lymphatic Dysregulation in Patients With Heart Failure: JACC Review Topic of the Week
Marat Fudim1, Husam M Salah2, Janarthanan Sathananthan3
1Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.
Insights
The lymphatic system regulates body fluid balance, but its role in heart failure (HF) is often overlooked. Targeting the lymphatic system offers a new approach for managing HF.
Area of Science:
- Cardiovascular Physiology
- Lymphatic System Biology
Background:
- The lymphatic system is crucial for fluid homeostasis.
- Its role in heart failure (HF) is underappreciated due to complex physiology and diagnostic challenges.
Purpose of the Study:
- To review the lymphatic system's physiological function in volume management.
- To highlight evidence of lymphatic system dysregulation in HF.
- To explore therapeutic targeting of the lymphatic system for HF management.
Main Methods:
- Literature review of lymphatic system physiology.
- Analysis of evidence linking lymphatic dysfunction to heart failure.
- Discussion of potential therapeutic strategies targeting lymphatic access.
Main Results:
- The lymphatic system actively manages fluid balance.
- Lymphatic system dysregulation is evident in both acute and chronic heart failure.
- Targeting the lymphatic system presents a novel therapeutic avenue for HF.
Conclusions:
- The lymphatic system's role in volume homeostasis is vital.
- Dysfunctional lymphatic system contributes significantly to heart failure pathophysiology.
- Future research should focus on lymphatic system-based therapies for heart failure.
Abstract:
The lymphatic system is an integral part of the circulatory system and plays an important role in the volume homeostasis of the human body. The complex anatomy and physiology paired with a lack of simple diagnostic tools to study the lymphatic system have led to an underappreciation of the contribution of the lymphatic system to acute and chronic heart failure (HF). Herein, we discuss the physiological role of the lymphatic system in volume management and the evidence demonstrating the dysregulation of the lymphatic system in HF. Further, we discuss the opportunity to target the lymphatic system in the management of HF and different potential approaches to accessing the lymphatic system.
