Neurohormonal Activation in Congestive Heart Failure and the Role of Vasopressin

Chatterjee, Kanu

doi:10.1016/j.amjcard.2005.03.003

Cited by 169 publications

(110 citation statements)

References 23 publications

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“…Arginine vasopressin (AVP) is an antidiuretic and vasoconstrictive hormone that is released from the hypothalamus in response to changes in plasma osmolality and hypovolemia; AVP production is upregulated in HF (65 ). AVP plays a role in the context of hyponatremia, a well-described, prognostically meaningful state in patients with HF (66 ).…”

Section: Neurohormonesmentioning

confidence: 99%

Emerging Biomarkers in Heart Failure

2012

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BACKGROUND Until recently, biomarker testing in heart failure (HF) syndromes has been viewed as an elective supplement to diagnostic evaluation of patients suspected to suffer from this condition. This approach to the use of biomarker testing contrasts with other cardiovascular diagnoses such as acute myocardial infarction, for which biomarkers are integral to disease process definition, risk stratification, and in some cases treatment decision making. CONTENT In this review we consider various perspectives on the evaluation of biomarkers in HF. In addition, we examine recent advances in the understanding of established biomarkers in HF (such as the natriuretic peptides), the elucidation of novel biomarkers potentially useful for the evaluation and management of patients with HF, and the growing understanding of important and relevant comorbidities in HF. We also review candidate biomarkers from a number of classes: (a) myocyte stretch, (b) myocyte necrosis, (c) systemic inflammation, (d) oxidative stress, (e) extracellular matrix turnover, (f) neurohormones, and (g) biomarkers of extracardiac processes, such as renal function. SUMMARY Novel applications of established biomarkers of HF as well as elucidation and validation of emerging assays for HF syndromes have collectively led to a growing interest in the more widespread use of such testing in patients affected by the diagnosis.

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Section: Neurohormonesmentioning

confidence: 99%

Emerging Biomarkers in Heart Failure

2012

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“…Sodium delivery to the distal tubule therefore declines, as do the effects of natriuretic peptides, leading to diuretic resistance and acute cardiac decompensation (6,7). Worsening of fluid overload may in turn negatively affect cardiac function and further reduce cardiac output (8).…”

mentioning

confidence: 99%

Peritoneal Ultrafiltration in Refractory Heart Failure: A Cohort Study

Bertoli

Musetti²,

Ciurlino

et al. 2014

Perit Dial Int

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♦ Introduction: Acutely decompensated heart failure (HF) in patients with diuretic resistance is often treated with extracorporeal ultrafiltration. Peritoneal ultrafiltration (PUF) has been proposed for the long-term management of severe HF after resolution of the acute episode. The aim of the present study was to evaluate the use of PUF in the treatment of chronic refractory HF in patients without endstage renal disease. ♦ Methods: This multicenter (10 nephrology departments throughout Italy) retrospective observational study included patients with severe HF refractory to maximized drug treatment. The patients were proposed for PUF because they had experienced at least 3 hospital admissions in the preceding year for acutely decompensated HF requiring extracorporeal ultrafiltration. ♦ Results: Of the 48 study patients (39 men, 9 women; mean age 74 ± 9 years), 30 received 1 nocturnal icodextrin exchange, 5 required 2 daily exchanges, and 13 received 2 -4 sessions per week of automated peritoneal dialysis. During the first year, renal function remained stable (initial: 20.8 ± 10.0 mL/min/1.73 m 2 ; end: 22.0 ± 13.6 mL/ min/1.73 m 2 ), while pulmonary artery systolic pressure declined to 40 ± 6.09 mmHg from 45.5 ± 9.18 mmHg (p = 0.03), with a significant concomitant improvement in New York Heart Association functional status. Hospitalizations decreased to 11 ± 17 days/patient-year from 43 ± 33 days/ patient-year before the start of PUF (p < 0.001). The incidence of peritonitis was 1 episode in 45 patient-months. Patient survival was 85% at 1 year and 56% at 2 years. ♦ Conclusions: This study confirms the satisfactory results of using PUF for chronic HF in elderly patients.

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“…Activation of V1aR causes arteriolar vasoconstriction resulting in increased systemic vascular resistance and afterload. At higher physiologic AVP levels, V1aR also mediates coronary vasoconstriction, thus decreasing coronary blood flow and cardiac contractility [18,24] . Stimulation of rat cardiac fibroblasts with AVP leads to cellular hypertrophy and proliferation via activation of the V1aR [25,26] .…”

Section: Arginine Vasopressinmentioning

confidence: 99%

“…Three different vasopressin receptors have been isolated: V1a, V1b (also known as V3) and V2 receptors ( Table 1). The V1b receptor is expressed in the anterior pituitary gland and pancreatic islet cells, and although it does not have a major role in CHF, it may mediate release of aldosterone via modulation of adrenocorticotropin hormone release [18] . The V1a receptor (V1aR) is present in blood vessels and the kidney, where stimulation is responsible for vascular constriction and possibly regulation of water reabsorption, respectively.…”

Section: Avp Antagonism In Adhfmentioning

confidence: 99%

Arginine vasopressin as a target in the treatment of acute heart failure

Gilotra

Russell

2014

WJC

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Congestive heart failure (CHF) is one of the most common reasons for hospitalization in the United States. Despite multiple different beneficial medications for the treatment of chronic CHF, there are no therapies with a demonstrated mortality benefit in the treatment of acute decompensated heart failure. In fact, studies of inotropes used in this setting have demonstrated more harm than good. Arginine vasopressin has been shown to be up regulated in CHF. When bound to the V1a and/or V2 receptors, vasopressin causes vasoconstriction, left ventricular remodeling and free water reabsorption. Recently, two drugs have been approved for use that antagonize these receptors. Studies thus far have indicated that these medications, while effective at aquaresis (free water removal), are safe and not associated with increased morbidity such as renal failure and arrhythmias. Both conivaptan and tolvaptan have been approved for the treatment of euvolemic and hypervolemic hyponatremia. We review the results of these studies in patients with heart failure. Core tip: Beneficial therapies in the setting of acute decompensated heart failure are limited. When bound to the V1a and/or V2 receptors, vasopressin, which is upregulated in heart failure, causes vasoconstriction, left ventricular remodeling and free water reabsorption. Over recent years, vasopressin antagonists such as conivaptan and tolvaptan have been investigated and approved for use in the appropriate setting. We review the evidence and implications behind use of vaptans in the setting of heart failure.Gilotra NA, Russell SD. Arginine vasopressin as a target in the treatment of acute heart failure.

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Neurohormonal Activation in Congestive Heart Failure and the Role of Vasopressin

Cited by 169 publications

References 23 publications

Emerging Biomarkers in Heart Failure

Emerging Biomarkers in Heart Failure

Peritoneal Ultrafiltration in Refractory Heart Failure: A Cohort Study

Arginine vasopressin as a target in the treatment of acute heart failure

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