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Neurohumoral Activation in Heart Failure

In patients with heart failure (HF), the neuroendocrine systems of the sympathetic nervous system (SNS), the renin–angiotensin–aldosterone system (RAAS) and the arginine vasopressin (AVP) system, are activated to various degrees producing often-observed tachycardia and concomitant increased systemic...

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Autores principales: Manolis, Antonis A., Manolis, Theodora A., Manolis, Antonis S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10607846/
https://www.ncbi.nlm.nih.gov/pubmed/37895150
http://dx.doi.org/10.3390/ijms242015472
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author Manolis, Antonis A.
Manolis, Theodora A.
Manolis, Antonis S.
author_facet Manolis, Antonis A.
Manolis, Theodora A.
Manolis, Antonis S.
author_sort Manolis, Antonis A.
collection PubMed
description In patients with heart failure (HF), the neuroendocrine systems of the sympathetic nervous system (SNS), the renin–angiotensin–aldosterone system (RAAS) and the arginine vasopressin (AVP) system, are activated to various degrees producing often-observed tachycardia and concomitant increased systemic vascular resistance. Furthermore, sustained neurohormonal activation plays a key role in the progression of HF and may be responsible for the pathogenetic mechanisms leading to the perpetuation of the pathophysiology and worsening of the HF signs and symptoms. There are biomarkers of activation of these neurohormonal pathways, such as the natriuretic peptides, catecholamine levels and neprilysin and various newer ones, which may be employed to better understand the mechanisms of HF drugs and also aid in defining the subgroups of patients who might benefit from specific therapies, irrespective of the degree of left ventricular dysfunction. These therapies are directed against these neurohumoral systems (neurohumoral antagonists) and classically comprise beta blockers, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers and vaptans. Recently, the RAAS blockade has been refined by the introduction of the angiotensin receptor–neprilysin inhibitor (ARNI) sacubitril/valsartan, which combines the RAAS inhibition and neprilysin blocking, enhancing the actions of natriuretic peptides. All these issues relating to the neurohumoral activation in HF are herein reviewed, and the underlying mechanisms are pictorially illustrated.
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spelling pubmed-106078462023-10-28 Neurohumoral Activation in Heart Failure Manolis, Antonis A. Manolis, Theodora A. Manolis, Antonis S. Int J Mol Sci Review In patients with heart failure (HF), the neuroendocrine systems of the sympathetic nervous system (SNS), the renin–angiotensin–aldosterone system (RAAS) and the arginine vasopressin (AVP) system, are activated to various degrees producing often-observed tachycardia and concomitant increased systemic vascular resistance. Furthermore, sustained neurohormonal activation plays a key role in the progression of HF and may be responsible for the pathogenetic mechanisms leading to the perpetuation of the pathophysiology and worsening of the HF signs and symptoms. There are biomarkers of activation of these neurohormonal pathways, such as the natriuretic peptides, catecholamine levels and neprilysin and various newer ones, which may be employed to better understand the mechanisms of HF drugs and also aid in defining the subgroups of patients who might benefit from specific therapies, irrespective of the degree of left ventricular dysfunction. These therapies are directed against these neurohumoral systems (neurohumoral antagonists) and classically comprise beta blockers, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers and vaptans. Recently, the RAAS blockade has been refined by the introduction of the angiotensin receptor–neprilysin inhibitor (ARNI) sacubitril/valsartan, which combines the RAAS inhibition and neprilysin blocking, enhancing the actions of natriuretic peptides. All these issues relating to the neurohumoral activation in HF are herein reviewed, and the underlying mechanisms are pictorially illustrated. MDPI 2023-10-23 /pmc/articles/PMC10607846/ /pubmed/37895150 http://dx.doi.org/10.3390/ijms242015472 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Manolis, Antonis A.
Manolis, Theodora A.
Manolis, Antonis S.
Neurohumoral Activation in Heart Failure
title Neurohumoral Activation in Heart Failure
title_full Neurohumoral Activation in Heart Failure
title_fullStr Neurohumoral Activation in Heart Failure
title_full_unstemmed Neurohumoral Activation in Heart Failure
title_short Neurohumoral Activation in Heart Failure
title_sort neurohumoral activation in heart failure
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10607846/
https://www.ncbi.nlm.nih.gov/pubmed/37895150
http://dx.doi.org/10.3390/ijms242015472
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