Medical management of acute heart failure

Kamran, Hayaan; Tang, W.H. Wilson

doi:10.12703/r/10-82

“…Central venous congestion can be easily assessed by the detection of “thoracic comets”, i.e., thoracic B lines, whereas peripheral congestion can be assessed by estimating central venous pressure [ 62 ]. The persistence of B lines before discharge is associated with a greater incidence of HF readmission and mortality; therefore, routine evaluation upon admission and discharge may be used to guide decongestive strategies and aid in prognostication [ 63 ]. For a broader assessment of venous congestion, the inferior vena cava diameter as well as intrahepatic and intrarenal Doppler flow parameters have also been associated with organ congestion and impaired natriuretic responses to diuretic therapy [ 64 ].…”

Section: Bnp and Nt-probnp In Acute Decompensated Heart Failure: Inpa...mentioning

confidence: 99%

Brain Natriuretic Peptide Biomarkers in Current Clinical and Therapeutic Scenarios of Heart Failure

Alcidi

¹

,

Goffredo

²

,

Correale

³

et al. 2022

JCM

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Brain natriuretic peptide (BNP) and its inactive N-terminal fragment, NT-proBNP, are serum biomarkers with key roles in the management of heart failure (HF). An increase in the serum levels of these peptides is closely associated with the pathophysiological mechanisms underlying HF such as the presence of structural and functional cardiac abnormalities, myocardial stretch associated with a high filling pressure and neuro-hormonal activation. As BNP and NT-proBNP measurements are possible, several studies have investigated their clinical utility in the diagnosis, prognostic stratification, monitoring and guiding therapy of patients with HF. BNP and NT-proBNP have also been used as criteria for enrollment in randomized trials evaluating the efficacy of new therapeutic strategies for HF. Nevertheless, the use of natriuretic peptides is still limited in clinical practice due to the controversial aspect of their use in different clinical settings. The purpose of this review is to discuss the main issues associated with using BNP and NT-proBNP serum levels in the management of patients with HF under current clinical and therapeutic scenarios.

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“…By the inhibition of GRK2 and sensitisation of β-adrenoceptor-dependent Gs/Gi-mediated signalling, RKIP exerts an inotropic effect in mice [ 20 ]. In patients, approved inotropic agents are applied for the short-term enhancement of the cardiac function in acute decompensated heart failure situations [ 164 , 165 , 166 , 167 ]. Ideally, inotropic agents would serve as a bridge to heart transplant.…”

Section: Rkip Causes Symptoms Of Heart Failure In Vivomentioning

confidence: 99%

“…Ideally, inotropic agents would serve as a bridge to heart transplant. However, inotropic agents have high risks and adverse effects [ 164 , 165 , 166 , 167 ]. Therefore, no inotrope is currently approved for long-term use in heart failure [ 167 ].…”

Section: Rkip Causes Symptoms Of Heart Failure In Vivomentioning

confidence: 99%

“…Therefore, no inotrope is currently approved for long-term use in heart failure [ 167 ]. Most inotropic agents are associated with an unfavourable outcome and an increased mortality [ 164 , 165 , 166 , 167 ]. Adverse effects are—at least partially—attributed to an increased oxygen and energy cost of contractility [ 165 ].…”

Section: Rkip Causes Symptoms Of Heart Failure In Vivomentioning

confidence: 99%

See 1 more Smart Citation

The RAF Kinase Inhibitor Protein (RKIP): Good as Tumour Suppressor, Bad for the Heart

Alla

¹

,

Quitterer

²

2022

Cells

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The RAF kinase inhibitor protein, RKIP, is a dual inhibitor of the RAF1 kinase and the G protein-coupled receptor kinase 2, GRK2. By inhibition of the RAF1-MAPK (mitogen-activated protein kinase) pathway, RKIP acts as a beneficial tumour suppressor. By inhibition of GRK2, RKIP counteracts GRK2-mediated desensitisation of G protein-coupled receptor (GPCR) signalling. GRK2 inhibition is considered to be cardioprotective under conditions of exaggerated GRK2 activity such as heart failure. However, cardioprotective GRK2 inhibition and pro-survival RAF1-MAPK pathway inhibition counteract each other, because inhibition of the pro-survival RAF1-MAPK cascade is detrimental for the heart. Therefore, the question arises, what is the net effect of these apparently divergent functions of RKIP in vivo? The available data show that, on one hand, GRK2 inhibition promotes cardioprotective signalling in isolated cardiomyocytes. On the other hand, inhibition of the pro-survival RAF1-MAPK pathway by RKIP deteriorates cardiomyocyte viability. In agreement with cardiotoxic effects, endogenous RKIP promotes cardiac fibrosis under conditions of cardiac stress, and transgenic RKIP induces heart dysfunction. Supported by next-generation sequencing (NGS) data of the RKIP-induced cardiac transcriptome, this review provides an overview of different RKIP functions and explains how beneficial GRK2 inhibition can go awry by RAF1-MAPK pathway inhibition. Based on RKIP studies, requirements for the development of a cardioprotective GRK2 inhibitor are deduced.

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“…The use of diuretics can reduce edema symptoms and preload. However, about 1/3 of patients may have diuretic resistance during treatment [9,10]. Hence, the diuretic effect of diuretics is weakened or disappeared before reaching the treatment goal of reducing edema [11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Effect of Hypertonic Saline Solution Combined with Furosemide on Acute Heart Failure: A Meta-Analysis

Li¹,

Liu

²

,

Li

³

2022

Computational and Mathematical Methods in Medicine

0

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Background. The efficacy of hypertonic saline solution (HSS) combined with furosemide in treating acute heart failure is controversial. This meta-analysis explores the efficacy of HSS combined with furosemide for the treatment of acute heart failure. Methods. Literature were searched from databases, including PubMed, Web of Knowledge, Embase, Central, CMKI, Wanfang, and VIP. The inclusion criteria were as follows: (1) subjects: patients with acute heart failure; (2) the experimental group and the control group were properly set up; (3) intervention measures: patients in the experimental group were treated with HSS + furosemide, and patients in the control group were treated with furosemide; (4) the outcomes included at least one of the following indicators: readmission rate, mortality, 24 h urine volume, weight loss, and serum creatinine; and (5) randomized controlled trial (RCT). The method recommended by Cochrane Collaboration Network was used to evaluate the risk bias. The heterogeneity among the studies was evaluated through the chi-square test, and the publication bias was assessed by the Egger test. The results were described using risk ratio (RR), mean difference (MD), and 95% confidence interval (CI). Results. The readmission rate in the HSS + furosemide group was lower than that in the furosemide group ( RR = 0.53 , 95% CI [0.46, 0.60], P < 0.00001 ), with no heterogeneity among the literature ( P = 0.21 , I 2 = 29 % ). Patients in the HSS + furosemide group had a lower mortality rate than that in the furosemide group ( RR = 0.55 , 95% CI [0.46, 0.65], P < 0.00001 ). The chi-square test result indicated no heterogeneity among the literature ( P = 0.25 , I 2 = 23 % ). Furthermore, the 24 h urine volume of patients in the HSS + furosemide group was higher than that in the furosemide group ( MD = 497.29 , 95% CI [457.61, 536.96], P < 0.00001 ). There was no heterogeneity among the literature ( P = 0.58 , I 2 = 0 % ). In contrast, patients in the HSS + furosemide group demonstrated a lower serum creatinine level than those in the furosemide group ( MD = − 0.45 , 95% CI [-0.51, -0.39], P < 0.00001 ). However, heterogeneity was observed among the literature ( P < 0.00001 , I 2 = 81 % ). The weight loss in the HSS + furosemide group was higher than that in the furosemide group ( MD = 1.83 , 95% CI [1.51, 2.15], P < 0.00001 ). There was no heterogeneity among the literature ( P = 0.42 , I 2 = 2 % ). Egger test showed no publication bias among the literature ( P > 0.05 ). Conclusion. Despite the heterogeneity and bias in our study, the combination of HSS with furosemide is promising in patients with acute heart failure. However, further research is still needed to confirm.

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Medical management of acute heart failure

Cited by 8 publications

References 142 publications

Brain Natriuretic Peptide Biomarkers in Current Clinical and Therapeutic Scenarios of Heart Failure

Brain Natriuretic Peptide Biomarkers in Current Clinical and Therapeutic Scenarios of Heart Failure

The RAF Kinase Inhibitor Protein (RKIP): Good as Tumour Suppressor, Bad for the Heart

Effect of Hypertonic Saline Solution Combined with Furosemide on Acute Heart Failure: A Meta-Analysis

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