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. 2012 Sep;1(3):256-68.
doi: 10.1177/2048872612457044.

Treating volume overload in acutely decompensated heart failure: established and novel therapeutic approaches

Katerina Koniari  1 , John Parissis, Ioannis Paraskevaidis, Maria Anastasiou-Nana
Affiliations

Treating volume overload in acutely decompensated heart failure: established and novel therapeutic approaches

Katerina Koniari et al. Eur Heart J Acute Cardiovasc Care. 2012 Sep.

Abstract

Background: Most patients hospitalized for acutely decompensated heart failure (ADHF) present with symptoms and signs of volume overload, which is also associated with substantially high rates of death and rehospitalization in ADHF.

Objective: To review the recent experimental and clinical evidence on existing therapeutic algorithms and investigational drugs used for the treatment of volume overload in ADHF patients.

Methods: A systematic search of peer-reviewed publications was performed on Medline and EMBASE from January 1990 to March 2012. The results of unpublished trials were obtained from presentations at national and international meetings.

Results: Apart from intrinsic renal insufficiency and neurohormonal activation, volume overload through venous congestion may be the primary haemodynamic factor triggering the worsening of renal function in ADHF patients. It is well known that heart and kidneys are closely interrelated and an acute or chronic disorder in one organ may induce acute or chronic dysfunction in the other organ. Established therapeutic strategies, (e.g. loop diuretics, vasodilators, and inotropes), are sometimes associated with limited clinical success due to tolerance and the need for frequent up titration of the doses in order to achieve the desired effect. That leads to an increasing interest in novel options, such as the use of adenosine A1 receptor antagonists, vasopressin antagonists, and renal-protective dopamine. Initial clinical trials have shown quite encouraging results in some heart failure subpopulations but have failed to demonstrate a clear beneficial role of these agents. On the other hand, ultrafiltration appears to be a more promising therapeutic procedure that will improve volume regulation, while preserving renal and cardiac function.

Conclusion: Further clinical studies are required in order to determine their net effect on renal function and potential cardiovascular outcomes. Until then, management of volume overload in ADHF patients remains a challenge for the clinicians.

Keywords: Decompensated heart failure; pathophysiology; renal failure; salt retention; therapeutic options; volume overload.

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Conflict of interest statement

Conflict of interest: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
The underlying pathophysiological mechanisms of volume overload in acutely decompensated heart failure AVP, arginine vasopressin; GFR, glomerular filtration rate; NO, nitric oxide; RAAS, renin–angiotensin–aldosterone system; ROS, reactive oxygen species; SNS, sympathetic nervous system.
Figure 2.
Figure 2.
ADHF treatment algorithm IABP, intraaortic balloon pump; SBP, systolic blood pressure; UF, ultrafiltration.
See this image and copyright information in PMC

References

    1. Nieminen MS. Pharmacological options for acute heart failure syndromes: current treatments and unmet needs. Eur Heart J Suppl 2005; 7(Suppl B): B20–B24
    1. Dec GW. Management of acute decompensated heart failure. Curr Probl Cardiol 2007; 32(6): 321–366 - PubMed
    1. Gheorghiade M, Filippatos G, De LL, et al. Congestion in acute heart failure syndromes: an essential target of evaluation and treatment. Am J Med 2006; 119: S3–S10 - PubMed
    1. The SOLVD Investigators Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1992; 325: 293–302 - PubMed
    1. Gottlieb SS, Abraham W, Butler J, et al. The prognostic importance of different definitions of worsening renal function in congestive heart failure. J Card Fail 2002; 8: 136–141 - PubMed