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)

TY - JOUR

T1 - 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)

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, Zoltán

AU - Parissis, John

AU - Platz, Elke

AU - Rudiger, Alain

AU - Ruschitzka, Frank

AU - Schäfer, Andreas

AU - Seferovic, Petar M

AU - Skouri, Hadi

AU - Yilmaz, Mehmet Birhan

AU - Mebazaa, Alexandre

N1 - © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

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 - Journal Article

KW - Review

U2 - 10.1002/ejhf.872

DO - 10.1002/ejhf.872

M3 - SCORING: Review article

C2 - 28560717

VL - 19

SP - 821

EP - 836

JO - EUR J HEART FAIL

JF - EUR J HEART FAIL

SN - 1388-9842

IS - 7

ER -