Prognostic markers in heart failure - Congestion, neurohormones, and the cardiorenal syndrome

John Edward Abellera Blair, Amin Manuchehry, Amar Chana, Joseph Rossi, Robert W. Schrier, John C Jr. Burnett, Mihai Gheorghiade

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

There are several markers of poor prognosis in heart failure (HF). The most established markers of poor prognosis in HF include neurohormonal (NH) imbalance, low ejection fraction (EF), ventricular arrhythmias, intraventricular conduction delays, low functional capacity, low SBP, and renal failure. The relative importance of these factors is unknown, as they have never been studied together. We present a 74-year-old female with nonischemic cardiomyopathy and an EF<20% who over 24 years since diagnosis, never developed clinical or hemodynamic congestion, was never hospitalized for HF, and never required a loop diuretic. She had all of the clinical indicators of poor prognosis in HF except for severe NH imbalance and renal failure, illustrating their importance in HF prognosis. While NH activation in HF is initially an adaptive mechanism, an imbalance of NH effectors causes congestion leading to a vicious cycle of congestion, renal dysfunction, and worsening of HF. The combination of NH activation and renal failure in HF is a vasomotor nephropathy known as the cardiorenal syndrome (CRS) and portends a poor prognosis. Pharmacological disruption of NH pathways early in HF may prevent CRS and, therefore, improve outcomes.

Original languageEnglish (US)
Pages (from-to)207-213
Number of pages7
JournalAcute Cardiac Care
Volume9
Issue number4
DOIs
StatePublished - 2007

Fingerprint

Cardio-Renal Syndrome
Neurotransmitter Agents
Heart Failure
Renal Insufficiency
Sodium Potassium Chloride Symporter Inhibitors
Cardiomyopathies
Stroke Volume
Cardiac Arrhythmias
Hemodynamics
Pharmacology

Keywords

  • Congestion
  • Heart failure
  • Kidney
  • Natriuretic peptides
  • New York Heart Association (NYHA)
  • Norepinephrine

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Emergency Medicine

Cite this

Blair, J. E. A., Manuchehry, A., Chana, A., Rossi, J., Schrier, R. W., Burnett, J. C. J., & Gheorghiade, M. (2007). Prognostic markers in heart failure - Congestion, neurohormones, and the cardiorenal syndrome. Acute Cardiac Care, 9(4), 207-213. https://doi.org/10.1080/17482940701606913

Prognostic markers in heart failure - Congestion, neurohormones, and the cardiorenal syndrome. / Blair, John Edward Abellera; Manuchehry, Amin; Chana, Amar; Rossi, Joseph; Schrier, Robert W.; Burnett, John C Jr.; Gheorghiade, Mihai.

In: Acute Cardiac Care, Vol. 9, No. 4, 2007, p. 207-213.

Research output: Contribution to journalArticle

Blair, JEA, Manuchehry, A, Chana, A, Rossi, J, Schrier, RW, Burnett, JCJ & Gheorghiade, M 2007, 'Prognostic markers in heart failure - Congestion, neurohormones, and the cardiorenal syndrome', Acute Cardiac Care, vol. 9, no. 4, pp. 207-213. https://doi.org/10.1080/17482940701606913
Blair, John Edward Abellera ; Manuchehry, Amin ; Chana, Amar ; Rossi, Joseph ; Schrier, Robert W. ; Burnett, John C Jr. ; Gheorghiade, Mihai. / Prognostic markers in heart failure - Congestion, neurohormones, and the cardiorenal syndrome. In: Acute Cardiac Care. 2007 ; Vol. 9, No. 4. pp. 207-213.
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