Congestion as a therapeutic target in acute heart failure syndromes.
This review begins by discussing the importance of clinical congestion as the dominant presenting manifestation of acute heart failure syndromes (AHFS). The pathophysiology of the cardiorenal syndrome is reviewed, including its relationship to the use of current therapy, that is, loop diuretics. The review then summarizes results from recent clinical trials evaluating therapy for AHFS, with a focus on those studies investigating ultrafiltration and vasopressin antagonists, and also, but more briefly, vasodilators and inotropic agents. Possible reasons for the success and failure of various therapeutic strategies directed at the congested state are discussed. The review concludes with recommendations for possible new strategies and specific investigations designed to benefit from the lessons learned from both the recent successful trials and the more numerous failures.
Cardiology Division, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN 55415, USA. srg_hcmc@yahoo.com
Steven R
SR
Goldsmith
Filippo
F
Brandimarte
Mihai
M
Gheorghiade
D000208:Acute Disease; D000241:Adenosine / Q000037:antagonists & inhibitors; D004231:Diuresis / Q000187:drug effects*; D004232:Diuretics / Q000627:therapeutic use*; D004487:Edema / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D004489:Edema, Cardiac / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006440:Hemofiltration; D006727:Hormone Antagonists / Q000627:therapeutic use; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D011654:Pulmonary Edema / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D013577:Syndrome; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use; D014667:Vasopressins / Q000037:antagonists & inhibitors
D004232:Diuretics; D006727:Hormone Antagonists; D014665:Vasodilator Agents; D014667:Vasopressins; D000241:Adenosine