Heart failure therapy at a crossroad: are there limits to the neurohormonal model?

Neurohormonal Hypothesis in Heart Failure

A ccording to the neurohormonal model, heart failure is a syndrome that develops because an initial heart injury activates endogenous neurohormonal systems that exert a deleterious effect to the myocardium and on the circulation. This new model regards heart failure primarily as a neurohormonal disorder with main pathophysiologic abnormality the activation of various neurohormonal systems. Arte...

A Neurohormonal Modulator in Heart Failure?

Clinical Use of Digitalis Glycosides The potential benefit of digoxin therapy in heart failure patients is thought to be related to its positive inotropic effect that increases cardiac output and thereby decreases ventricular filling pressures.2 Although digoxin is undoubtedly an inotropic agent in tissue preparations,3 this effect, in contrast to other inotropic agents, is not consistently tra...

Renal neurohormonal regulation in heart failure decompensation.

Decompensation in heart failure occurs when the heart fails to balance venous return with cardiac output, leading to fluid congestion and contributing to mortality. Decompensated heart failure can cause acute kidney injury (AKI), which further increases mortality. Heart failure activates signaling systems that are deleterious to kidneys such as renal sympathetic nerve activity (RSNA), renin-ang...

Titin isoforms in heart failure: are there benefits to supersizing?

Titin is a giant sarcomeric protein that functions as a complex, molecular spring. Its presence in the sarcomere of striated muscle was recognized in the 1980s,1 but its functions have been appreciated only over the past decade, in considerable measure because of the efforts of Granzier, Labeit, Linke, and coworkers.2–4 Earlier work by these investigators and others4 delineated the spring prope...

The role of the neurohormonal system in heart failure.