Commentary - Current Trends in Cardiology (2023) Volume 7, Issue 10
Pathophysiological mechanisms of organ injury in acute heart failureQianli Wan*
Department of Cardiology, Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Corresponding Author:
- Qianli Wan
Department of Cardiology
Shanghai Jiaotong University School of Medicine
Received: 27-Sep-2023, Manuscript No. AACC-23-114270; Editor assigned: 30-Sep-2023, Pre QC No. AACC-23-114270(PQ); Reviewed: 16-Oct-2023, QC No. AACC-23-114270; Revised: 21-Oct-2023, Manuscript No. AACC-23-114270(R), Published: 28-Oct-2023,DOI:10.35841/aacc-7.10.207
Citation: Wan Q. Pathophysiological mechanisms of organ injury in acute heart failure. J Cell Biol Metab. 2023;7(10):207
The primary pathophysiological driver of organ injury in AHF is a compromised cardiac output. The failing heart struggles to eject an adequate volume of blood with each contraction, leading to decreased perfusion of organs. Organs with high metabolic demands, such as the brain, kidneys, and liver, are particularly vulnerable to reduced blood flow. This reduced perfusion can result in hypoxia and nutrient deprivation, triggering a series of events that culminate in organ damage. In response to reduced cardiac output, the body activates the sympathetic nervous system and the renin-angiotensinaldosterone system (RAAS). These neurohormonal systems are designed to maintain blood pressure and perfusion to vital organs but can become overactive in AHF. Chronic activation of these systems can lead to vasoconstriction, sodium and water retention, and increased afterload on the heart, further exacerbating organ injury . The compromised circulation in AHF can trigger a systemic inflammatory response. The release of proinflammatory cytokines and activation of immune cells can cause endothelial dysfunction and lead to microvascular injury. This inflammatory cascade can contribute to organ damage by disrupting the normal functioning of tissues and exacerbating the underlying pathophysiology of AHF.
Oxidative stress occurs when there is an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify them. In AHF, the decreased oxygen delivery to tissues and the activation of inflammatory pathways can result in increased ROS production . These highly reactive molecules can damage cellular structures and contribute to organ injury by causing oxidative damage to DNA, proteins, and lipids. In AHF, periods of reduced blood flow (ischemia) can be followed by the restoration of blood flow (reperfusion) when medical interventions are initiated. This phenomenon can lead to ischemia-reperfusion injury, which is characterized by the generation of ROS and the activation of inflammatory pathways. This injury can further exacerbate organ damage and dysfunction, particularly in the heart itself. The organs most susceptible to injury in AHF include the kidneys, liver, and lungs. Renal Dysfunction: Reduced cardiac output and activation of the RAAS can lead to renal hypoperfusion, resulting in prerenal azotemia. The kidneys respond by retaining sodium and water, which can exacerbate volume overload and pulmonary congestion. This can further impair cardiac function and create a vicious cycle of worsening organ injury .
Hepatic Dysfunction: The compromised circulation can also affect the liver, leading to hepatic congestion and impaired liver function. This can result in impaired drug metabolism, coagulation abnormalities, and the accumulation of waste products, contributing to further systemic organ dysfunction.
Pulmonary Dysfunction: In AHF, impaired cardiac function can lead to pulmonary congestion and the accumulation of fluid in the lungs, resulting in acute respiratory distress syndrome (ARDS). This can further compromise oxygenation and contribute to multi-organ failure. Reduced cerebral perfusion in AHF can lead to neurological manifestations such as confusion, delirium, and even coma. In severe cases, inadequate cerebral blood flow can result in cerebral ischemia and infarction. These neurological complications can have lasting consequences and significantly impact a patient's overall prognosis [4,5].
Acute heart failure is a complex and life-threatening condition that can lead to multi-organ injury and dysfunction. The pathophysiological mechanisms underlying organ injury in AHF are multifaceted, involving impaired cardiac output, neurohormonal activation, inflammation, oxidative stress, ischemia-reperfusion injury, and end-organ dysfunction. Understanding these mechanisms is crucial for guiding clinical management and developing targeted treatment strategies to mitigate organ injury in AHF patients. Timely intervention and a holistic approach to care that addresses the underlying pathophysiology are essential in improving outcomes for individuals with acute heart failure.
- Ingelsson E. The validity of a diagnosis of heart failure in a hospital discharge register. Eur J Heart Fail. 2005;7:787–91.
- Rosano GMC. Impact analysis of heart failure across European countries: an ESC-HFA position paper. ESC Heart Fail;26.
- Lindmark K. Epidemiology of heart failure and trends in diagnostic work-up: a retrospective, population-based cohort study in Sweden. Clin Epidemiol. 2019;11:231–44.
- Birkeland KI. Heart failure and chronic kidney disease manifestation and mortality risk associations in type 2 diabetes: a large multinational cohort study. Diabetes Obes Metab. 2020;22:1607–18.
- Seferovic PM. The Heart Failure Association Atlas: heart failure epidemiology and management statistics 2019. Eur J Heart Fail. 2021;23:906–14.