Hide
Show all
Email this article The role of right-sided heart failure in patients with Cardio-Renal Syndrome
Abstract
Deteriorated renal function in patients with acute or chronic heart failure represents an important clinical challenge of modern medicine. The term Cardio-Renal Syndrome (CRS) has been brought into use to characterize heart-kidney interaction leading to dysfunction of one another. The pathophysiology of impaired renal function in cardiovascular disease is complex and not precisely understood. Recent investigations suggest that management of patients based on just low-flow theory does not lead to improved outcomes. Relative importance of Right-Sided Heart Failure (RSHF) has not been properly evaluated.
This paper provides a concise overview of definition, classification and pathophysiology of the CRS and its subtypes, particularly types 1 and 2 with special emphasis on the role of RSHF and increased Central Venous Pressure (CVP). The role of RSHF in CRS is difficult to ascertain, as it is frequently combined with left sided heart failure and renal dysfunction can also raise right atrial pressure by causing fluid retention, regardless of concomitant cardiac dysfunction. Proper understanding of CRS subtypes is crucial, as therapies directed towards one organ system may have beneficial or unfavorable effects on the other.
Keywords
Full Text:
PDFReferences
Smith GL, Lichtman JH, Bracken MB, Shlipak MG, Phillips CO, DiCapua P, Krumholz HM: Renal impairment and outcomes in heart failure: systematic review and meta-analysis. Journal of the American College of Cardiology 2006, 47(10):1987-1996.
Ezekowitz J, McAlister FA, Humphries KH, Norris CM, Tonelli M, Ghali WA, Knudtson ML: The association among renal insufficiency, pharmacotherapy, and outcomes in 6,427 patients with heart failure and coronary artery disease. Journal of the American College of Cardiology 2004, 44(8):1587-1592.
Hillege HL, Girbes AR, de Kam PJ, Boomsma F, de Zeeuw D, Charlesworth A, Hampton JR, van Veldhuisen DJ: Renal function, neurohormonal activation, and survival in patients with chronic heart failure. Circulation 2000, 102(2):203-210.
Adams KF, Jr., Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT, Berkowitz RL, Galvao M, Horton DP: Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). American heart journal 2005, 149(2):209-216.
Heywood JT, Fonarow GC, Costanzo MR, Mathur VS, Wigneswaran JR, Wynne J: High prevalence of renal dysfunction and its impact on outcome in 118,465 patients hospitalized with acute decompensated heart failure: a report from the ADHERE database. Journal of cardiac failure 2007, 13(6):422-430.
Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS: Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. American journal of kidney diseases : the official journal of the National Kidney Foundation 2003, 41(1):1-12.
Chan EJ, Dellsperger KC: Cardiorenal Syndrome: The Clinical Cardiologists' Perspective. Cardiorenal medicine 2011, 1(1):13-22.
Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, McCullough PA, Kasiske BL, Kelepouris E, Klag MJ et al: Kidney Disease as a Risk Factor for Development of Cardiovascular Disease: A Statement From the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation 2003, 108(17):2154-2169.
Ronco C: Cardio-Renal Syndromes: Introduction. Seminars in nephrology 2012, 32(1):1-2.
Ronco C, Haapio M, House AA, Anavekar N, Bellomo R: Cardiorenal syndrome. Journal of the American College of Cardiology 2008, 52(19):1527-1539.
Bagshaw SM, Cruz DN, Aspromonte N, Daliento L, Ronco F, Sheinfeld G, Anker SD, Anand I, Bellomo R, Berl T et al: Epidemiology of cardio-renal syndromes: workgroup statements from the 7th ADQI Consensus Conference. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 2010, 25(5):1406-1416.
Forman DE, Butler J, Wang Y, Abraham WT, O'Connor CM, Gottlieb SS, Loh E, Massie BM, Rich MW, Stevenson LW et al: Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. Journal of the American College of Cardiology 2004, 43(1):61-67.
Ismail Y, Kasmikha Z, Green HL, McCullough PA: Cardio-Renal Syndrome Type 1: Epidemiology, Pathophysiology, and Treatment. Seminars in nephrology, 32(1):18-25.
Cruz DN: Cardiorenal syndrome in critical care: the acute cardiorenal and renocardiac syndromes. Advances in chronic kidney disease 2013, 20(1):56-66.
Jois P, Mebazaa A: Cardio-renal syndrome type 2: epidemiology, pathophysiology, and treatment. Seminars in nephrology 2012, 32(1):26-30.
Chuasuwan A, Kellum JA: Cardio-renal syndrome type 3: epidemiology, pathophysiology, and treatment. Seminars in nephrology 2012, 32(1):31-39.
Clementi A, Virzi GM, Goh CY, Cruz DN, Granata A, Vescovo G, Ronco C: Cardiorenal syndrome type 4: a review. Cardiorenal medicine 2013, 3(1):63-70.
Virzì GM, Corradi V, Panagiotou A, Gastaldon F, Cruz DN, de Cal M, Clementi M, Ronco C: ADPKD: Prototype of Cardiorenal Syndrome Type 4. International journal of nephrology 2011, 2011:12.
Pateinakis P, Papagianni A: Cardiorenal Syndrome Type 4—Cardiovascular Disease in Patients with Chronic Kidney Disease: Epidemiology, Pathogenesis, and Management. International journal of nephrology 2011, 2011.
Soni SS, Ronco C, Pophale R, Bhansali AS, Nagarik AP, Barnela SR, Saboo SS, Raman A: Cardio-renal syndrome type 5: epidemiology, pathophysiology, and treatment. Seminars in nephrology 2012, 32(1):49-56.
Schrier RW: Cardiorenal versus renocardiac syndrome: is there a difference? Nature clinical practice Nephrology 2007, 3(12):637.
Mehta RL, Rabb H, Shaw AD, Singbartl K, Ronco C, McCullough PA, Kellum JA: Cardiorenal syndrome type 5: clinical presentation, pathophysiology and management strategies from the eleventh consensus conference of the Acute Dialysis Quality Initiative (ADQI). Contributions to nephrology 2013, 182:174-194.
Cicoira M, Anker SD, Ronco C: Cardio-renal cachexia syndromes (CRCS): pathophysiological foundations of a vicious pathological circle. Journal of cachexia, sarcopenia and muscle 2011, 2(3):135-142.
Schrier RW, Abraham WT: Hormones and Hemodynamics in Heart Failure. New England Journal of Medicine 1999, 341(8):577-585.
Logeart D, Tabet JY, Hittinger L, Thabut G, Jourdain P, Maison P, Tartiere JM, Solal AC: Transient worsening of renal function during hospitalization for acute heart failure alters outcome. International journal of cardiology 2008, 127(2):228-232.
Chinnaiyan KM, Alexander D, McCullough PA: Role of angiotensin II in the evolution of diastolic heart failure. Journal of clinical hypertension 2005, 7(12):740-747.
Pastori S, Virzi GM, Brocca A, de Cal M, Cantaluppi V, Castellani C, Fedrigo M, Thiene G, Valente ML, Angelini A et al: Cardiorenal Syndrome Type 1: Activation of Dual Apoptotic Pathways. Cardiorenal medicine 2015, 5(4):306-315.
Virzi GM, de Cal M, Day S, Brocca A, Cruz DN, Castellani C, Cantaluppi V, Bolin C, Fedrigo M, Thiene G et al: Pro-Apoptotic Effects of Plasma from Patients with Cardiorenal Syndrome on Human Tubular Cells. American journal of nephrology 2015, 41(6):474-484.
Pastori S, Virzi GM, Brocca A, de Cal M, Clementi A, Vescovo G, Ronco C: Cardiorenal syndrome type 1: a defective regulation of monocyte apoptosis induced by proinflammatory and proapoptotic factors. Cardiorenal medicine 2015, 5(2):105-115.
Iyngkaran P, Schneider H, Devarajan P, Anavekar N, Krum H, Ronco C: Cardio-renal syndrome: new perspective in diagnostics. Seminars in nephrology 2012, 32(1):3-17.
McCullough PA, Ahmad A: Cardiorenal syndromes. World journal of cardiology 2011, 3(1):1-9.
Ahmed A, Campbell RC: Epidemiology of Chronic Kidney Disease in Heart Failure. Heart failure clinics 2008, 4(4):387-399.
Wencker D: Acute cardio-renal syndrome: Progression from congestive heart failure to congestive kidney failure. Current heart failure reports 2007, 4(3):134-138.
Bock JS, Gottlieb SS: Cardiorenal syndrome: new perspectives. Circulation 2010, 121(23):2592-2600.
House AA, Haapio M, Lassus J, Bellomo R, Ronco C: Therapeutic Strategies for Heart Failure in Cardiorenal Syndromes. American Journal of Kidney Diseases, 56(4):759-773.
Shamseddin MK, Parfrey PS: Mechanisms of the cardiorenal syndromes. Nature reviews Nephrology 2009, 5(11):641-649.
Damman K, Navis G, Smilde TD, Voors AA, van der Bij W, van Veldhuisen DJ, Hillege HL: Decreased cardiac output, venous congestion and the association with renal impairment in patients with cardiac dysfunction. European journal of heart failure 2007, 9(9):872-878.
Ronco C, Kaushik M, Valle R, Aspromonte N, Peacock Iv WF: Diagnosis and Management of Fluid Overload in Heart Failure and Cardio-Renal Syndrome: The “5B” Approach. Seminars in nephrology 2012, 32(1):129-141.
Mullens W, Abrahams Z, Skouri HN, Francis GS, Taylor DO, Starling RC, Paganini E, Tang WH: Elevated intra-abdominal pressure in acute decompensated heart failure: a potential contributor to worsening renal function? Journal of the American College of Cardiology 2008, 51(3):300-306.
Tang WH, Mullens W: Cardiorenal syndrome in decompensated heart failure. Heart 2010, 96(4):255-260.
Damman K, van Deursen VM, Navis G, Voors AA, van Veldhuisen DJ, Hillege HL: Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease. Journal of the American College of Cardiology 2009, 53(7):582-588.
Uthoff H, Breidthardt T, Klima T, Aschwanden M, Arenja N, Socrates T, Heinisch C, Noveanu M, Frischknecht B, Baumann U et al: Central venous pressure and impaired renal function in patients with acute heart failure. European journal of heart failure 2011, 13(4):432-439.
Ahmed A, Rich MW, Sanders PW, Perry GJ, Bakris GL, Zile MR, Love TE, Aban IB, Shlipak MG: Chronic Kidney Disease Associated Mortality in Diastolic Versus Systolic Heart Failure: A Propensity Matched Study†. The American journal of cardiology 2007, 99(3):393-398.
Kitzman DW, Upadhya B: Heart Failure With Preserved Ejection FractionA Heterogenous Disorder With Multifactorial Pathophysiology∗. Journal of the American College of Cardiology 2014, 63(5):457-459.
Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM: Trends in Prevalence and Outcome of Heart Failure with Preserved Ejection Fraction. New England Journal of Medicine 2006, 355(3):251-259.
Borlaug BA, Paulus WJ: Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment. European heart journal 2011, 32(6):670-679.
Fonarow GC, Stough WG, Abraham WT, Albert NM, Gheorghiade M, Greenberg BH, O'Connor CM, Sun JL, Yancy CW, Young JB: Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF Registry. Journal of the American College of Cardiology 2007, 50(8):768-777.
Lazzeri C, Valente S, Tarquini R, Gensini GF: Cardiorenal syndrome caused by heart failure with preserved ejection fraction. International journal of nephrology 2011, 2011:634903.
Pecoits-Filho R, Bucharles S, Barberato SH: Diastolic heart failure in dialysis patients: mechanisms, diagnostic approach, and treatment. Seminars in dialysis 2012, 25(1):35-41.
Rusinaru D, Buiciuc O, Houpe D, Tribouilloy C: Renal function and long-term survival after hospital discharge in heart failure with preserved ejection fraction. International journal of cardiology 2011, 147(2):278-282.
Voelkel NF, Quaife RA, Leinwand LA, Barst RJ, McGoon MD, Meldrum DR, Dupuis J, Long CS, Rubin LJ, Smart FW et al: Right Ventricular Function and Failure: Report of a National Heart, Lung, and Blood Institute Working Group on Cellular and Molecular Mechanisms of Right Heart Failure. Circulation 2006, 114(17):1883-1891.
Haddad F, Doyle R, Murphy DJ, Hunt SA: Right Ventricular Function in Cardiovascular Disease, Part II: Pathophysiology, Clinical Importance, and Management of Right Ventricular Failure. Circulation 2008, 117(13):1717-1731.
Dini FL, Demmer RT, Simioniuc A, Morrone D, Donati F, Guarini G, Orsini E, Caravelli P, Marzilli M, Colombo PC: Right ventricular dysfunction is associated with chronic kidney disease and predicts survival in patients with chronic systolic heart failure. European journal of heart failure 2012, 14(3):287-294.
Greyson CR: Evaluation of right ventricular function. Current cardiology reports 2011, 13(3):194-202.
Schmid E, Hilberath JN, Blumenstock G, Shekar PS, Kling S, Shernan SK, Rosenberger P, Nowak-Machen M: Tricuspid annular plane systolic excursion (TAPSE) predicts poor outcome in patients undergoing acute pulmonary embolectomy. Heart Lung Vessel 2015, 7(2):151-158.
Reems MM, Aumann M: Central venous pressure: principles, measurement, and interpretation. Compend Contin Educ Vet 2012, 34(1):E1.
Ganda A, Onat D, Demmer RT, Wan E, Vittorio TJ, Sabbah HN, Colombo PC: Venous Congestion and Endothelial Cell Activation in Acute Decompensated Heart Failure. Current heart failure reports 2010, 7(2).
Damman K, Kalra PR, Hillege H: Pathophysiological mechanisms contributing to renal dysfunction in chronic heart failure. Journal of renal care 2010, 36 Suppl 1:18-26.
Refbacks
- There are currently no refbacks.
ISSN: 2346-8491 (online)