American Heart Journal
Volume 155, Issue 1 , Pages 9-18 , January 2008

The pathophysiology of acute heart failure—Is it all about fluid accumulation?

  • Gad Cotter, MD

      Affiliations

    • Duke University Medical Center, the Duke Clinical Research Institute, Durham, NC
    • Corresponding Author InformationReprint requests: Gad Cotter, MD, Duke Clinical Research Institute, 2400 Pratt St, Durham, NC 27715, USA.
  • ,
  • G. Michael Felker, MD

      Affiliations

    • Duke University Medical Center, the Duke Clinical Research Institute, Durham, NC
  • ,
  • Kirkwood F. Adams, MD

      Affiliations

    • University of North Carolina, Chapel Hill, NC
  • ,
  • Olga Milo-Cotter, MD

      Affiliations

    • Duke University Medical Center, the Duke Clinical Research Institute, Durham, NC
  • ,
  • Christopher M. O'Connor, MD

      Affiliations

    • Duke University Medical Center, the Duke Clinical Research Institute, Durham, NC

Received 19 October 2005 ,Accepted 12 February 2006.

References 

  1. American Heart Association . 2003 Heart and stroke statistical update. Dallas (Tex): American Heart Association; 2002;
  2. Lee DS, Mamdani MM, Austin PC, et al. Trends in heart failure outcomes and pharmacotherapy: 1992 to 2000. Am J Med. 2004;116:581–589
  3. Packer M, Coats AJS, Fowler MB, et al. Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med. 2001;344:1651–1658
  4. Cleland JGF, Swedberg K, Follath F, et al. The EuroHeart Failure survey programme—a survey on the quality of care among patients with heart failure in Europe: part 1: patient characteristics and diagnosis. Eur Heart J. 2003;24:442–463
  5. Adams J, Fonarow GC, Emerman CL, et al. 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). Am Heart J. 2005;149:209–216
  6. Lee DS, Austin PC, Rouleau JL, et al. Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. JAMA. 2003;290:2581–2587
  7. McMurray JJV, Ostergren J, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet. 2003;362:767–771
  8. O'Connor CM, Stough WG, Gallup DS, et al. Demographics, clinical characteristics, and outcomes of patients hospitalized for decompensated heart failure: observations from the IMPACT-HF Registry. J Card Fail. 2005;11:200–205
  9. Cotter G, Moshkovitz Y, Milovanov O, et al. Acute heart failure: a novel approach to its pathogenesis and treatment. Eur J Heart Fail. 2002;4:227–234
  10. Endorsed by the European Society of Intensive Care Medicine , Task FM, Nieminen MS, et al. Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology. Eur Heart J. 2005;26:384–416
  11. Verwey HF, Molhoek SG, Sweeney R, et al. Patient symptoms and device-based activity for decompensated vs. non-decompensated heart failure patients. J Card Fail. 2005;12:170
  12. Lewin J, Ledwidge M, O'Loughlin C, et al. Clinical deterioration in established heart failure: what is the value of BNP and weight gain in aiding diagnosis?. Eur J Heart Fail. 2005;7:953–957
  13. Gheorghiade M, Gattis WA, O'Connor CM, et al. Effects of tolvaptan, a vasopressin antagonist, in patients hospitalized with worsening heart failure: a randomized controlled trial. JAMA. 2004;291:1963–1971
  14. Cotter G, Weissgarten J, Metzkor E, et al. Increased toxicity of high-dose furosemide versus low-dose dopamine in the treatment of refractory congestive heart failure. Clin Pharmacol Ther. 1997;62:187–193
  15. Butler J, Forman DE, Abraham WT, et al. Relationship between heart failure treatment and development of worsening renal function among hospitalized patients. Am Heart J. 2004;147:331–338
  16. Buckle J, Sharkey P, Myriski P, et al. Improving outcomes for patients hospitalized with CHF. Manag Care Q. 2002;10:30–40
  17. Cline CM, Bjorck-Linne AK, Israelsson BY, et al. Non-compliance and knowledge of prescribed medication in elderly patients with heart failure. Eur J Heart Fail. 1999;1:145–149
  18. Shemesh E, Rudnick A, Kaluski E, et al. A prospective study of posttraumatic stress symptoms and nonadherence in survivors of a myocardial infarction (MI). Gen Hosp Psychiatry. 2001;23:215–222
  19. van der Wal MH, Jaarsma T, van Veldhuisen DJ. Non-compliance in patients with heart failure; how can we manage it?. Eur J Heart Fail. 2005;7:5–17
  20. Granger BB, Swedberg K, Ekman I, et al. Relationship of adherence to candesartan and placebo with outcomes in chronic heart failure: results from the CHARM programme. Lancet. 2005;366:2005–2011
  21. Littmann L. Large T wave inversion and QT prolongation associated with pulmonary edema: a report of nine cases. J Am Coll Cardiol. 1999;34:1106–1110
  22. Sugiura T, Takase H, Toriyama T, et al. Circulating levels of myocardial proteins predict future deterioration of congestive heart failure. J Card Fail. 2005;11:504–509
  23. Gattis WA, O'Connor CM, Gallup DS, et al. Predictors of 60-day death or rehospitalization in patients admitted with decompensated heart failure: insights from the IMPACT-HF Trial. J Am Coll Cardiol. 2003;17:694
  24. Gheorghiade M, Gattis Stough W, Adams J, et al. The Pilot Randomized Study of Nesiritide Versus Dobutamine in Heart Failure (PRESERVD-HF). Am J Cardiol. 2005;96:18–25
  25. O'Connor CM, Gattis WA, Adams KF, et al. Tezosentan in patients with acute heart failure and acute coronary syndromes: results of the Randomized Intravenous TeZosentan Study (RITZ-4). J Am Coll Cardiol. 2003;41:1452–1457
  26. Gattis WA, O'Connor CM, Hasselblad V, et al. Usefulness of an elevated troponin-I in predicting clinical events in patients admitted with acute heart failure and acute coronary syndrome (from the RITZ-4 trial). Am J Cardiol. 2004;93:1436–1437
  27. Khot UN, Jia G, Moliterno DJ, et al. Prognostic importance of physical examination for heart failure in non–ST-elevation acute coronary syndromes: the enduring value of Killip classification. JAMA. 2003;290:2174–2181
  28. Velazquez EJ, Pfeffer MA. Acute heart failure complicating acute coronary syndromes: a deadly intersection. Circulation. 2004;109:440–442
  29. Benza RL, Felker GM, Zabel KM, et al. Arrhythmias in heart failure exacerbations: the OPTIME-CHF study. Circulation. 2001;104:525
  30. Pierard LA, Lancellotti P. The role of ischemic mitral regurgitation in the pathogenesis of acute pulmonary edema. N Engl J Med. 2004;351:1627–1634
  31. Gandhi SK, Powers JC, Nomeir AM, et al. The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med. 2001;344:17–22
  32. Milo-Cotter O, Adams KF, O'Connor CM, et al. Acute heart failure associated with high admission blood pressure–a distinct vascular disorder. Eur J Heart Fail. 2007;9:178–183
  33. Cotter G, Metzkor E, Kaluski E, et al. Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet. 1998;351:389–393
  34. Kaluski E, Kobrin I, Zimlichman R, et al. RITZ-5: randomized intravenous tezosentan (an endothelin-A/B antagonist) for the treatment of pulmonary edema: a prospective, multicenter, double-blind, placebo-controlled study. J Am Coll Cardiol. 2003;41:204–210
  35. Cotter G, Moshkovitz Y, Kaluski E, et al. The role of cardiac power and systemic vascular resistance in the pathophysiology and diagnosis of patients with acute congestive heart failure. Eur J Heart Fail. 2003;5:443–451
  36. Kawaguchi M, Hay I, Fetics B, et al. Combined ventricular systolic and arterial stiffening in patients with heart failure and preserved ejection fraction: implications for systolic and diastolic reserve limitations. Circulation. 2003;107:714–720
  37. Redfield MM, Jacobsen SJ, Borlaug BA, et al. Age- and gender-related ventricular-vascular stiffening: a community-based study. Circulation. 2005;112:2254–2262
  38. Vlachopoulos C, Dima I, Aznaouridis K, et al. Acute systemic inflammation increases arterial stiffness and decreases wave reflections in healthy individuals. Circulation. 2005;112:2193–2200
  39. Uriel N, Torre-Amione G, Milo O, et al. Echocardiographic ejection fraction in patients with acute heart failure: correlations with hemodynamic, clinical, and neurohormonal measures and short-term outcome. Eur J Heart Fail. 2005;7:815–819
  40. Logeart D, Thabut G, Jourdain P, et al. Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure. J Am Coll Cardiol. 2004;43:635–641
  41. Banerjee P, Clark AL, Nikitin N, et al. Diastolic heart failure. Paroxysmal or chronic?. Eur J Heart Fail. 2004;6:427–431
  42. Al Ahmad A, Rand WM, Manjunath G, et al. Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction. J Am Coll Cardiol. 2001;38:955–962
  43. Dries DL, Exner DV, Domanski MJ, et al. The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. J Am Coll Cardiol. 2000;35:681–689
  44. Ljungman S, Laragh JH, Cody RJ. Role of the kidney in congestive heart failure: relationship of cardiac index to kidney function. Drugs. 1990;39:10–21
  45. Fonarow GC, Adams KF, Abraham WT, et al. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA. 2005;293:572–580
  46. Felker GM, Leimberger JD, Califf RM, et al. Risk stratification after hospitalization for decompensated heart failure. J Card Fail. 2004;10:460–466
  47. Gottlieb SS, Abraham W, Butler J, et al. The prognostic importance of different definitions of worsening renal function in congestive heart failure. J Card Fail. 2002;8:136–141
  48. Janssen SPM, Gayan-Ramirez G, Van Den Bergh A, et al. Interleukin-6 causes myocardial failure and skeletal muscle atrophy in rats. Circulation. 2005;111:996–1005
  49. Pagani FD, Baker LS, Hsi C, et al. Left ventricular systolic and diastolic dysfunction after infusion of tumor necrosis factor-alpha in conscious dogs. J Clin Invest. 1992;90:389–398
  50. Milo O, Cotter G, Kaluski E, et al. Comparison of inflammatory and neurohormonal activation in cardiogenic pulmonary edema secondary to ischemic versus nonischemic causes. Am J Cardiol. 2003;92:222–226
  51. Sato Y, Takatsu Y, Kataoka K, et al. Serial circulating concentrations of C-reactive protein, interleukin (IL)-4, and IL-6 in patients with acute left heart decompensation. Clin Cardiol. 1999;22:811–813
  52. Sogaard P, Egeblad H, Kim WY, et al. Tissue Doppler imaging predicts improved systolic performance and reversed left ventricular remodeling during long-term cardiac resynchronization therapy. J Am Coll Cardiol. 2002;40:723–730
  53. Bader H, Garrigue S, Lafitte S, et al. Intra-left ventricular electromechanical asynchrony: a new independent predictor of severe cardiac events in heart failure patients. J Am Coll Cardiol. 2004;43:248–256
  54. Cleland JGF, Daubert JC, Erdmann E, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352:1539–1549
  55. Brophy JM, Deslauriers G, Rouleau JL. Long-term prognosis of patients presenting to the emergency room with decompensated congestive heart failure. Can J Cardiol. 1994;10:543–547
  56. O'Connor CM, Gurbel PA, Serebruany VL. Usefulness of soluble and surface-bound P-selectin in detecting heightened platelet activity in patients with congestive heart failure. Am J Cardiol. 1999;83:1345–1349
  57. Atherton JJ, Moore TD, Lele SS, et al. Diastolic ventricular interaction in chronic heart failure. Lancet. 1997;349:1720–1724
  58. Matthay MA, Folkesson HG, Clerici C. Lung epithelial fluid transport and the resolution of pulmonary edema. Physiol Rev. 2002;82:569–600

PII: S0002-8703(07)00823-X

doi: 10.1016/j.ahj.2006.02.038

American Heart Journal
Volume 155, Issue 1 , Pages 9-18 , January 2008