Biomarker Assessment of Lymphatic System Remodeling in Acute Heart Failure

Abstract

Despite diagnostic and therapeutic advances, decompensated heart failure (HF) remains one of the leading causes of hospitalizations in the United States. 1 Clark KAA Reinhardt SW Chouairi F et al. Trends in Heart Failure Hospitalizations in the US from 2008 to 2018. J Card Fail. Feb 2022; 28: 171-180https://doi.org/10.1016/j.cardfail.2021.08.020 Google Scholar Expansion of the extracellular fluid is behind the cardinal signs and symptoms of decompensated HF (e.g., shortness of breath, peripheral edema, ascites) and potentiates end-organ dysfunction (e.g., kidney dysfunction). 2 Aronson D. The interstitial compartment as a therapeutic target in heart failure. Front Cardiovasc Med. 2022; 9933384https://doi.org/10.3389/fcvm.2022.933384 Google Scholar The lymphatic circulatory system plays a key role in body fluid homeostasis; it drains fluid from the interstitial space (at a rate similar to the rate of fluid accumulation in the interstitial space) and return it to the central venous system via a complex network of blind-end capillaries, collecting lymphatic vessels, trunks, and lymphoid tissue. 3 Fudim M Salah HM Sathananthan J et al. Lymphatic Dysregulation in Patients With Heart Failure: JACC Review Topic of the Week. J Am Coll Cardiol. Jul 6 2021; 78: 66-76https://doi.org/10.1016/j.jacc.2021.04.090 Google Scholar Dysregulation of the lymphatic system is associated with the development of self-propagating congestive mechanisms and is one of the key features of congestion in HF. The role of lymphatic dysregulation in HF has been underappreciated mainly due to the lack of simple diagnostic tools to assess the lymphatic system and the inherent complexity in visualizing and accessing it. Husam M. Salah Paulino Alvarez Relationship of Vascular Endothelial Growth Factor C, a Lymphangiogenesis Modulator, With Edema Formation, Congestion and Outcomes in Acute Heart FailureJournal of Cardiac FailurePreviewIn acute heart failure (AHF), congestion is the result mainly of sodium and water accumulation driven by complex processes, including hydrostatic, humoral and neurohumoral mechanisms.1 Fluid retention is tightly linked to the expansion of extracellular space and the overproduction of interstitial fluid, which further promote edema formation. Physiologically, this process is compensated by an increase in interstitial drainage by the lymphatic system.1 Rise in lymphatic flow and lymphangiogenesis are the adaptative mechanisms that enable the lymphatic system to remove overproduced interstitial fluid. Full-Text PDF Open Access