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Review
. 2022 Jun 17:9:910100.
doi: 10.3389/fcvm.2022.910100. eCollection 2022.

Biomarkers of Volume Overload and Edema in Heart Failure With Reduced Ejection Fraction

Roxana Mihaela Chiorescu  1   2 , Roxana-Daiana Lazar  3 , Sándor-Botond Buksa  2 , Mihaela Mocan  1   2 , Dan Blendea  1   3
Affiliations
Review

Biomarkers of Volume Overload and Edema in Heart Failure With Reduced Ejection Fraction

Roxana Mihaela Chiorescu et al. Front Cardiovasc Med. .

Abstract

From a pathogenetic point of view, heart failure (HF) is characterized by the activation of several neurohumoral pathways with a role in maintaining the cardiac output and the adequate perfusion pressure in target organs and tissues. Decreased cardiac output in HF with reduced ejection fraction causes activation of the sympathetic nervous system, the renin angiotensin aldosterone system, arginine-vasopressin system, natriuretic peptides, and endothelin, all of which cause water and salt retention in the body. As a result, patients will present clinically as the main symptoms: dyspnea and peripheral edema caused by fluid redistribution to the lungs and/or by fluid overload. By studying these pathophysiological mechanisms, biomarkers with a prognostic and therapeutic role in the management of edema were identified in patients with HF with low ejection fraction. This review aims to summarize the current data from the specialty literature of such biomarkers with a role in the pathogenesis of edema in HF with low ejection fraction. These biomarkers may be the basis for risk stratification and the development of new therapeutic means in the treatment of edema in these patients.

Keywords: biomarkers; edema; heart failure; physiopathology; volume overload.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Mechanisms of fluid overload and edema in heart failure with reduced ejection fraction. Adapted after Adams et al. (8) (HFrEF, heart failure with reduced ejection fraction; Na, sodium; RAAS, renin-angiotensin-aldosterone system).
Figure 2
Figure 2
Biomarkers of different physiopathological pathways responsible for volume overload and edema heart failure with reduced ejection fraction. Adapted from Ibrahim et al. (84) and Oikonomou et al. (91) (HFrEF, heart failure with reduced ejection fraction; Na, sodium; RAAS, renin-angiotensin-aldosterone system).
See this image and copyright information in PMC

References

    1. Timmis A, Townsend N, Gale C, Grobbee R, Maniadakis N, Flather M, et al. . European Society of Cardiology: cardiovascular disease statistics 2017. Eur Heart J. (2018) 39:508–77. 10.1093/eurheartj/ehx628 - DOI - PubMed
    1. Townsend N, Kazakiewicz D, Lucy Wright F, Timmis A, Huculeci R, Torbica A, et al. . Epidemiology of cardiovascular disease in Europe. Nat Rev Cardiol. (2022) 19:133–43. 10.1038/s41569-021-00607-3 - DOI - PubMed
    1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. . 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American college of cardiology foundation/American Heart Association task force on practice guidelines. Circulation. (2013) 128:1810–52. 10.1161/CIR.0b013e31829e8807 - DOI - PubMed
    1. Bozkurt B, Coats AJS, Tsutsui H, Abdelhamid CM, Adamopoulos S, Albert N, et al. . Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese Heart Failure Association. Eur J Heart Fail. (2021) 23:352–80. 10.1002/ejhf.2115 - DOI - PubMed
    1. Zheng H, Liu X, Rao US, Patel KP. Increased renal ENaC subunits and sodium retention in rats with chronic heart failure. Am J Physiol Ren Physiol. (2011) 300:641–9. 10.1152/ajprenal.00254.2010 - DOI - PMC - PubMed