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Refractory congestive heart failure: overview and application of extracorporeal ultrafiltration
1Cleveland Clinic Foundation, OH 44195-5176, USA.
Insights
Ultrafiltration effectively treats advanced congestive heart failure (CHF) by interrupting neurohormonal cycles. This method improves symptoms and quality of life for patients with refractory CHF, potentially reducing hospital readmissions.
Area of Science:
- Cardiology
- Nephrology
- Critical Care Medicine
Background:
- Congestive heart failure (CHF) from ischemic cardiomyopathy is a growing epidemic.
- Advanced CHF involves heightened neuroendocrine activity, leading to increased vascular resistance and impaired heart function.
- Refractory CHF (NYHA class III-IV) often resists conventional treatments due to persistent neurohumoral activation.
Purpose of the Study:
- To evaluate the efficacy of ultrafiltration in managing refractory congestive heart failure.
- To determine if ultrafiltration can interrupt the neurohumoral-hemodynamic cycle in advanced CHF patients.
Main Methods:
- Ultrafiltration was applied to patients with NYHA class III-IV CHF and low urine output (<1000 mL/d).
- The study assessed the impact of ultrafiltration on fluid overload, edema, and response to diuretics.
Main Results:
- Ultrafiltration successfully relieved pulmonary and peripheral edema, and reduced ascites.
- Patients showed enhanced responsiveness to subsequent diuretic therapy after ultrafiltration.
- Volume removal improved overall volume status and normalized filling pressures, reducing clinical symptoms.
Conclusions:
- Ultrafiltration is a viable treatment for refractory CHF, offering significant symptom relief and improved quality of life.
- Early data suggest ultrafiltration may decrease hospital readmissions and intensive care unit stays for CHF patients.
Abstract:
Congestive heart failure (CHF) from ischemic cardiomyopathy has emerged as an epidemic health problem. The pathogenesis of CHF is characterized by heightened activity of many neuroendocrine factors, including norepinephrine, angiotensin II, and arginine vasopressin, which lead to heightened systemic vascular resistance and further impedance of left ventricular ejection. Once CHF reaches New York Heart Association (NYHA) class III or IV with heightened activity of the many neurohumoral factors, it tends to be refractory to conventional therapy of vasodilators, inotropic agents, and diuretics. Treatment of refractory CHF appears to require a break in the neurohumoral hemodynamic vicious cycle, and ultrafiltration appears able to produce this interruption. Ultrafiltration has been shown to be successful in patients with NYHA class III to VI CHF and urine output less than 1,000 mL/d. It relieves pulmonary edema, reduces ascites and peripheral edema, and enhances the response to subsequent diuretic therapy. In patients with refractory CHF, the ability to provide adequate volume removal, thus improving overall volume status, normalizing filling pressures, and reducing clinical symptoms, offers an improvement in overall quality of life. Early results have shown that ongoing therapy actually may be associated with decreased hospital readmissions or, at the very least, shortened intensive care unit length of stay.