Fluid Volume Homeostasis in Heart Failure: A Tale of 2 Circulations

Area of Science:

• Cardiovascular Physiology
• Fluid Homeostasis
• Heart Failure Pathophysiology

Background:

• Fluid volume regulation relies on intravascular and interstitial-lymphatic systems.
• Heart failure (HF) disrupts this balance, causing volume remodeling and expansion in both compartments.
• These changes initially compensate but can lead to volume overload and congestion in advanced HF.

Purpose of the Study:

• To enhance recognition of the pathophysiologic and clinical importance of interlinked circulatory systems in volume regulation and chronic HF.
• To promote a better understanding of intravascular and interstitial-lymphatic fluid compartment interactions.
• To aid the development of novel management strategies for HF, focusing on the interstitial-lymphatic system.

Main Methods:

• Review of existing literature on fluid volume homeostasis in health and heart failure.
• Analysis of pathophysiologic mechanisms affecting intravascular and interstitial compartments.
• Exploration of clinical manifestations of volume overload and congestion in HF.

Main Results:

• HF involves complex volume remodeling in both intravascular and interstitial compartments.
• Pathophysiologic mechanisms in HF can lead to significant fluid expansion.
• These fluid shifts contribute to the clinical presentation of HF congestion.

Conclusions:

• Integrated understanding of intravascular and interstitial-lymphatic systems is crucial for managing HF.
• The interstitial-lymphatic system is often undertargeted in HF management.
• Novel therapeutic strategies may emerge from a more holistic view of these interacting fluid compartments.