Organ dysfunction, injury and failure in acute heart failure: 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)

Veli-Pekka Harjola*, Wilfried Mullens, Marek Banaszewski, Johann Bauersachs, Hans-Peter Brunner-La Rocca, Ovidiu Chioncel, Sean P. Collins, Wolfram Doehner, Gerasimos S. Filippatos, Andreas J. Flammer, Valentin Fuhrmann, Mitja Lainscak, Johan Lassus, Matthieu Legrand, Josep Masip, Christian Mueller, Zoltan Papp, John Parissis, Elke Platz, Alain RudigerFrank Ruschitzka, Andreas Schaefer, Petar M. Seferovic, Hadi Skouri, Mehmet Birhan Yilmaz, Alexandre Mebazaa

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

186 Citations (Web of Science)

Abstract

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.

Original languageEnglish
Pages (from-to)821-836
Number of pages16
JournalEuropean journal of heart failure
Volume19
Issue number7
DOIs
Publication statusPublished - Jul 2017

Keywords

  • Heart failure
  • Multiple organ failure
  • Venous congestion
  • CARDIOGENIC PULMONARY-EDEMA
  • ACUTE KIDNEY INJURY
  • EMERGENCY-DEPARTMENT PATIENTS
  • WORSENING RENAL-FUNCTION
  • INTENSIVE-CARE-UNIT
  • GELATINASE-ASSOCIATED LIPOCALIN
  • ACUTE MYOCARDIAL-INFARCTION
  • NATRIURETIC PEPTIDE LEVELS
  • 3RD UNIVERSAL DEFINITION
  • LIVER-FUNCTION TESTS

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