Patients with cardiac amyloidosis have a greater neurohormonal activation than those with non-amyloidotic heart failure

Heart involvement in Cardiac Amyloidosis (CA) results in a worsening of the prognosis in almost all patients with both light-chain (AL) and transthyretin amyloidosis (ATTR). The mainstream CA is a restrictive cardiomyopathy with hypertrophic phenotype at cardiac imaging that clinically leads to heart failure with preserved ejection fraction (HFpEF). An early diagnosis is essential to reduce cardiac damage and to improve the prognosis. Many therapies are available, but most of them have late benefits to cardiac function; for this reason, novel therapies are going to come soon.

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Current Concepts of Neurohormonal Activation in Heart Failure

AACN Advanced Critical Care ◽

10.4037/15597768-2008-4004 ◽

2008 ◽

Vol 19 (4) ◽

pp. 364-385

Author(s):

Christopher S. Lee ◽

Nancy C. Tkacs

Keyword(s):

Heart Failure ◽

Cardiovascular Effects ◽

Practice Research ◽

Neurohormonal Activation ◽

Kinin System ◽

Clinical Nursing ◽

System 2 ◽

System Activation ◽

Research And Education ◽

Pharmacologic Agents

Neurohormonal activation is a commonly cited array of phenomena in the body’s physiologic response to heart failure. Although various neurohormones and pharmacologic agents that moderate their pathophysiologic effects have been reviewed in the nursing literature, both the mechanisms of neurohormonal system activation and cellular and organ system effects have been described only in brief. Accordingly, this article reviews mechanisms of neurohormonal activation and describes cellular and cardiovascular effects of the (1) sympathetic nervous system, (2) renin-angiotensin-aldosterone system, (3) kallikrein-kininogen-kinin system, (4) vasopressinergic system, (5) natriuretic peptide systems, and (6) endothelin in the context of heart failure. This article implicitly details the physiologic basis for numerous current and potential future pharmacologic agents used in the management of heart failure. It is intended that this article be used as a reference for advanced clinical nursing practice, research, and education.

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Endothelin in neurohormonal activation in heart failure

Coronary Artery Disease ◽

10.1097/00019501-200311000-00004 ◽

2003 ◽

Vol 14 (7) ◽

pp. 495-500 ◽

Cited By ~ 7

Author(s):

Guido Boerrigter ◽

John C. Burnett

Keyword(s):

Heart Failure ◽

Neurohormonal Activation

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Total 12-Lead QRS Voltage in Patients Having Orthotopic Heart Transplantation for Heart Failure Caused by Adriamycin-Induced Cardiomyopathy

Cardiology ◽

10.1159/000492748 ◽

2018 ◽

Vol 141 (3) ◽

pp. 172-175 ◽

Cited By ~ 1

Author(s):

William C. Roberts ◽

Sarah Haque ◽

Shelley A. Hall

Keyword(s):

Heart Failure ◽

Heart Transplantation ◽

Cardiac Amyloidosis ◽

Cardiac Sarcoidosis ◽

Medical Center ◽

Severe Heart Failure ◽

Orthotopic Heart Transplantation ◽

S Wave ◽

Baylor University ◽

Before And After

Objective: Although several studies have described the effects of adriamycin on the heart, electrocardiographic total 12-lead QRS voltage (distance in millimeters from the peak of the R wave to the nadir of either the Q or S wave, whichever was deeper, with 10 mm [1 mV] being standard) both before and after orthotopic heart transplantation (OHT) has not been reported. This study describes the total 12-lead QRS voltage in 8 patients studied at Baylor University Medical Center at Dallas, from 1994 to June 2018, who underwent OHT for severe heart failure caused by anthracycline-induced cardiomyopathy. Method: Prior to OHT, the total 12-lead non-paced QRS voltages ranged from 86 to 189 mm (mean 125 ± 56) and for paced QRS voltages from 82 to 113 mm (mean 97 ± 15). The total 12-lead QRS voltages post-OHT ranged from 100 to 190 mm (mean 130 ± 30). Total 12-lead QRS voltages were lower in patients with a pacemaker than without. Results/Conclusion: These low voltages are like those found in patients with carcinoid syndrome, severe cardiac adiposity, cardiac amyloidosis, and cardiac sarcoidosis.

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Multimodality imaging can shift the clinical approach and prognosis of a patient: from heart failure and angina to cardiac amyloidosis

Romanian Journal of Cardiology ◽

10.47803/rjc.2021.31.1.102 ◽

2021 ◽

Vol 31 (1) ◽

pp. 103-110

Author(s):

Alexandra Maria Chitroceanu ◽

Alina Ioana Nicula ◽

Roxana Cristina Rimbas ◽

Mihaela Andreescu ◽

Cristina Popp ◽

...

Keyword(s):

Heart Failure ◽

Cardiac Amyloidosis ◽

Multimodality Imaging ◽

Clinical Status ◽

Decompensated Heart Failure ◽

Response To Therapy ◽

Al Amyloidosis ◽

Clinical Approach ◽

Non Invasive ◽

Life Threatening

AL (light chain) amyloidosis is a life threatening disease. Untreated patients with involvement of the heart, a condition known as cardiac amyloidosis (CA), tend to have the most rapid disease progression and worst prognosis. Therefore, it is essential to early recognize the signs of symptoms of CA, and to identify the affected individuals with readily available non-invasive tests, as timely therapy can prolong life. Different imaging tests are used to diagnose and stratify the risk of the disease noninvasively, and to follow-up of the disease course and response to therapy. In this light, we present a case of a woman with cardiovascular risk factors, initially admitted for typical angina and decompensated heart failure (HF), who was later diagnosed with AL amyloidosis with cardiac involvement, by using multimodality imaging assessment in a step-by-step fashion. This changed completely the prognosis of the patient. Timely chemotherapy and stem cell transplantation led to an improvement in clinical status, biomarkers, and in a regression of amyloid myocardial infi ltration showed by imaging.

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Metabolic syndrome and heart failure: mechanism and management

Medicine and Pharmacy Reports ◽

10.15386/mpr-1884 ◽

2021 ◽

Author(s):

Sidhi Laksono Purwowiyoto ◽

Ananta Siddhi Prawara

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Insulin Resistance ◽

Metabolic Syndrome ◽

World Population ◽

Neurohormonal Activation ◽

Comprehensive Management ◽

The World ◽

Current Guidelines ◽

Careful Management

Heart failure (HF) and metabolic syndrome (MetS) are syndromes that affect a large proportion of the world population. MetS is known to be one of the risk factors of HF, and it can also act as comorbidity in HF. This review aims to further discuss the mechanism of MetS in causing HF, the management of MetS in order to prevent HF, and the management of MetS in HF patients. Visceral adiposity is the primary trigger of MetS which is followed by chronic inflammation, insulin resistance, and neurohormonal activation. All the mechanisms causing MetS play also an important role in the progression of HF. The MetS approach can be achieved by managing its components according to the current guidelines and careful management of MetS should be done in patients with HF. MetS is closely related to the progression of HF so that comprehensive management which involves a multidisciplinary team is necessary for managing patients with metabolic syndrome and heart failure.

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