TY - JOUR
T1 - Organ dysfunction, injury and failure in acute heart failure
T2 - from pathophysiology to diagnosis and management. A review on behalf of the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)
AU - Harjola, Veli-Pekka
AU - Mullens, Wilfried
AU - Banaszewski, Marek
AU - Bauersachs, Johann
AU - Brunner-La Rocca, Hans-Peter
AU - Chioncel, Ovidiu
AU - Collins, Sean P.
AU - Doehner, Wolfram
AU - Filippatos, Gerasimos S.
AU - Flammer, Andreas J.
AU - Fuhrmann, Valentin
AU - Lainscak, Mitja
AU - Lassus, Johan
AU - Legrand, Matthieu
AU - Masip, Josep
AU - Mueller, Christian
AU - Papp, Zoltan
AU - Parissis, John
AU - Platz, Elke
AU - Rudiger, Alain
AU - Ruschitzka, Frank
AU - Schaefer, Andreas
AU - Seferovic, Petar M.
AU - Skouri, Hadi
AU - Yilmaz, Mehmet Birhan
AU - Mebazaa, Alexandre
PY - 2017/7
Y1 - 2017/7
N2 - Organ injury and impairment are commonly observed in patients with acute heart failure (AHF), and congestion is an essential pathophysiological mechanism of impaired organ function. Congestion is the predominant clinical profile in most patients with AHF; a smaller proportion presents with peripheral hypoperfusion or cardiogenic shock. Hypoperfusion further deteriorates organ function. The injury and dysfunction of target organs (i.e. heart, lungs, kidneys, liver, intestine, brain) in the setting of AHF are associated with increased risk for mortality. Improvement in organ function after decongestive therapies has been associated with a lower risk for post-discharge mortality. Thus, the prevention and correction of organ dysfunction represent a therapeutic target of interest in AHF and should be evaluated in clinical trials. Treatment strategies that specifically prevent, reduce or reverse organ dysfunction remain to be identified and evaluated to determine if such interventions impact mortality, morbidity and patient-centred outcomes. This paper reflects current understanding among experts of the presentation and management of organ impairment in AHF and suggests priorities for future research to advance the field.
AB - Organ injury and impairment are commonly observed in patients with acute heart failure (AHF), and congestion is an essential pathophysiological mechanism of impaired organ function. Congestion is the predominant clinical profile in most patients with AHF; a smaller proportion presents with peripheral hypoperfusion or cardiogenic shock. Hypoperfusion further deteriorates organ function. The injury and dysfunction of target organs (i.e. heart, lungs, kidneys, liver, intestine, brain) in the setting of AHF are associated with increased risk for mortality. Improvement in organ function after decongestive therapies has been associated with a lower risk for post-discharge mortality. Thus, the prevention and correction of organ dysfunction represent a therapeutic target of interest in AHF and should be evaluated in clinical trials. Treatment strategies that specifically prevent, reduce or reverse organ dysfunction remain to be identified and evaluated to determine if such interventions impact mortality, morbidity and patient-centred outcomes. This paper reflects current understanding among experts of the presentation and management of organ impairment in AHF and suggests priorities for future research to advance the field.
KW - Heart failure
KW - Multiple organ failure
KW - Venous congestion
KW - CARDIOGENIC PULMONARY-EDEMA
KW - ACUTE KIDNEY INJURY
KW - EMERGENCY-DEPARTMENT PATIENTS
KW - WORSENING RENAL-FUNCTION
KW - INTENSIVE-CARE-UNIT
KW - GELATINASE-ASSOCIATED LIPOCALIN
KW - ACUTE MYOCARDIAL-INFARCTION
KW - NATRIURETIC PEPTIDE LEVELS
KW - 3RD UNIVERSAL DEFINITION
KW - LIVER-FUNCTION TESTS
U2 - 10.1002/ejhf.872
DO - 10.1002/ejhf.872
M3 - (Systematic) Review article
C2 - 28560717
SN - 1388-9842
VL - 19
SP - 821
EP - 836
JO - European journal of heart failure
JF - European journal of heart failure
IS - 7
ER -