Pathophysiology of AHF (acute heart failure)

AHF is a 1-2-3 cascade to acute damage

  • AHF is a complex pathophysiologic process that can be divided into 3 distinct phases that can result in
    acute damage1:
    1. Initiation
    2. Amplification
    3. Damage

Biomarkers may be useful in diagnosing and establishing prognosis or disease severity of AHF1,2

References:

  1. Mann DL, Zipes DP, Libby P, Bonow RO, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Saunders; 2015.
  2. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;128(16):e240-e327.
  3. Lassus JP, Nieminen MS, Peuhkurinen K, et al; for FINN-AKVA study group. Markers of renal function and acute kidney injury in acute heart failure: definitions and impact on outcomes of the cardiorenal syndrome. Eur Heart J. 2010;31(22):2791-2798.
  4. Cotter G, Milo O, Davison BA. Increased mortality after an acute heart failure episode: new pathophysiological insights from the RELAX-AHF study and beyond. Curr Heart Fail Rep. 2014;11(1):19-30.
  5. Marti CN, Gheorghiade M, Kalogeropoulos AP, Georgiopoulou VV, Quyyumi AA, Javed Butler J. Endothelial dysfunction, arterial stiffness, and heart failure. J Am Coll Cardiol. 2012;60(16):1455-1469.
  6. Halls ML, Bathgate RA, Summers RJ. Relaxin family peptide receptors RXFP1 and RXFP2 modulate cAMP signaling by distinct mechanism. Mol Pharmacol. 2006;70(1):214-226.
  7. Failli P, Nistri S, Quattrone S, et al. Relaxin up-regulates inducible nitric oxide synthase expression and nitric oxide generation in rat coronary endothelial cells. FASEB J. 2002;16(2):252-254.
  8. Jin ZG, Ueba H, Tanimoto T, Lungu AO, Frame MD, Berk MC. Ligand-independent activation of vascular endothelial growth factor receptor 2 by fluid shear stress regulates activation of endothelial nitric oxide synthase. Circ Res. 2003;93(4):354-363.
  9. Ignjatovic T, Stanisavljevic S, Brovkovych V, Skidgel RA, Erös EG. Kinin B1 receptors stimulate nitric oxide production in endothelial cells: signaling pathways activated by antiotensin I-converting enzyme inhibitors and peptide ligands. Mol Pharmacol. 2004;66(5):1310-1316.
  10. 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(2):331-338.
  11. Nikolaou M, Parissis J, Yilmaz MB, et al. Liver function abnormalities, clinical profile, and outcome in acute decompensated heart failure. Eur Heart J. 2013;34(10):742-749.
  12. Manzano-Fernández S, Januzzi JL Jr, Boronat-Garcia M, et al. ß-trace protein and cystatin C as predictors of long-term outcomes in patients with acute heart failure. J Am Coll Cardiol. 2011;57(7):849-858.
  13. Peacock WF IV, De Marco T, Fonarow GC, et al; for ADHERE Investigators. Cardiac troponin and outcome in acute heart failure. N Engl J Med. 2008;358(20):2117-2126.
  14. Eurlings LW, Sanders-van Wijk S, van Kraaij DJW, et al. Risk stratification with the use of serial N-terminal pro-B-type natriuretic peptide measurements during admission and early after discharge in heart failure patients: post hoc analysis of the PRIMA Study. J Card Fail. 2014;20(12):881-890.
  15. Kociol RD, Horton JR, Fonarow GC, et al. Admission, discharge, or change in B-type natriuretic peptide and long-term outcomes: data from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) linked to Medicare claims. Circ Heart Fail. 2011;4(5):628-636.
  16. Bettencourt P, Azevedo A, Pimenta J, Friões F, Ferreira S, Ferreira A. N-terminal–pro-brain natriuretic peptide predicts outcome after hospital discharge in heart failure patients. Circulation. 2004;110(15):2168-2174.
  17. You JJ, Austin PC, Alter DA, Ko DT, Tu JV. Relation between cardiac troponin I and mortality in acute decompensated heart failure. Am Heart J. 2007;153(4):462-470.
  18. Shirakabe A, Hata N, Kobayashi N, et al. Long-term prognostic impact after acute kidney injury in patients with acute heart failure. Int Heart J. 2012;53(5):313-319.
  19. Lee DS, Austin PC, Rouleau JL, Liu PP, Naimark D, Tu JV. Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. JAMA. 2003;290(19):2581-2587.
  20. Chang PP, Chambless LE, Shahar E, et al. Incidence and survival of hospitalized acute decompensated heart failure in four US communities (from the Atherosclerosis Risk in Communities Study). Am J Cardiol. 2014;113(3):504-510.