More hormones spilt in heart failure: linking renal sympathetic activation to clinical outcome

Abstract

This editorial refers to ‘Long-term outcome in relation to renal sympathetic activity in patients with chronic heart failure’† by M. Petersson et al. , on page 906 ‘Neurohumoral activation’ is a commonly used term in papers dealing with heart failure. Although the term is short, the process is vast and complex: perhaps as complex as it gets. As heart failure affects almost all organs through reduced blood supply and compensatory regulation of auto-, para-, neuro-, and endocrine mechanisms, it seems overwhelming to rank the individual effect and regulation of one bioactive substance to the effects and regulations of others. Which substance affects which system and in what order through the course of disease progression? To make matters more complex, new substances are still being added to the long list of hormones, despite the fact that it has been over 100 years since the discovery of hormones. With this in mind, it should be recapitulated that the principal discovery of hormones was made by Ernest H. Starling, who also contributed to our present understanding of the pumping heart.1 One cannot help but wonder how he would try to make sense of the neurohumoral puzzle in heart failure. Scientists focused early on the heart as a target as well as a secretory organ. The sympathetic component to the heart was an important element in early cardiac physiology, which further fuelled the … *Corresponding author. Tel: +45 3545 5509; fax: +45 3545 4640. E-mail address : jpg{at}dadlnet.dk