Myocardial oedema: pathophysiological basis and implications for the failing heart
Francisco Vasques-Nóvoa1,2, António Angélico-Gonçalves1,2, José M G Alvarenga1,2
1Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Porto, Portugal.
Insights
Myocardial edema, or fluid buildup in the heart, disrupts function and is linked to heart failure. Understanding fluid balance is key to new treatments for heart conditions.
Area of Science:
- Cardiology
- Physiology
- Pathophysiology
Background:
- Myocardial fluid homeostasis involves complex interactions between microvascular filtration, interstitial hydration, cardiomyocyte water uptake, and lymphatic removal.
- Dysregulation of these mechanisms can lead to myocardial edema, impacting heart function and structure.
- Myocardial edema is increasingly recognized as a prognostic indicator in heart failure, detectable via cardiac magnetic resonance.
Purpose of the Study:
- To review the factors controlling myocardial water balance in healthy and failing hearts.
- To explore the physical and molecular interactions within the cardiac microvasculature, interstitium, and lymphatics.
- To identify potential new therapeutic strategies for managing myocardial edema in heart failure.
Main Methods:
- Literature review of current knowledge on myocardial fluid balance.
- Analysis of experimental evidence regarding microvascular barrier, interstitial, and lymphatic functions.
- Synthesis of findings to understand disruptions in heart failure.
Main Results:
- Fluid accumulation in the myocardium disrupts architecture, intercellular communication, and metabolism, reducing contractility and increasing stiffness.
- Cardiac magnetic resonance is a key tool for identifying myocardial edema and its prognostic implications.
- Growing evidence elucidates the mechanisms underlying fluid dysregulation in heart failure.
Conclusions:
- Myocardial edema is a significant clinical finding with prognostic value in heart failure.
- A deeper understanding of fluid balance mechanisms offers new therapeutic targets.
- Further research into the physical and molecular underpinnings of myocardial water balance is warranted.
Abstract:
Myocardial fluid homeostasis relies on a complex interplay between microvascular filtration, interstitial hydration, cardiomyocyte water uptake and lymphatic removal. Dysregulation of one or more of these mechanisms may result in myocardial oedema. Interstitial and intracellular fluid accumulation disrupts myocardial architecture, intercellular communication, and metabolic pathways, decreasing contractility and increasing myocardial stiffness. The widespread use of cardiac magnetic resonance enabled the identification of myocardial oedema as a clinically relevant imaging finding with prognostic implications in several types of heart failure. Furthermore, growing experimental evidence has contributed to a better understanding of the physical and molecular interactions in the microvascular barrier, myocardial interstitium and lymphatics and how they might be disrupted in heart failure. In this review, we summarize current knowledge on the factors controlling myocardial water balance in the healthy and failing heart and pinpoint the new potential therapeutic avenues.
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