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Eur J Heart Fail. 2016 Jun;18(6):588-98. doi: 10.1002/ejhf.497. Epub 2016 Feb 10.

Connecting heart failure with preserved ejection fraction and renal dysfunction: the role of endothelial dysfunction and inflammation.

Author information

1
University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
2
University Medical Center Utrecht, Department of Nephrology and Hypertension, Utrecht, The Netherlands.
3
Department of Physiology, Cardiology, Pathology, and Surgery, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
4
Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.
5
University of Groningen, Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands.
6
National Heart Centre Singapore and, Duke-National University of Singapore Graduate School Medicine, Singapore.
7
University of Groningen, Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands.

Abstract

Renal dysfunction in heart failure with preserved ejection fraction (HFpEF) is common and is associated with increased mortality. Impaired renal function is also a risk factor for developing HFpEF. A new paradigm for HFpEF, proposing a sequence of events leading to myocardial remodelling and dysfunction in HFpEF, was recently introduced, involving inflammatory, microvascular, and cardiac components. The kidney might play a key role in this systemic process. Renal impairment causes metabolic and systemic derangements in circulating factors, causing an activated systemic inflammatory state and endothelial dysfunction, which may lead to cardiomyocyte stiffening, hypertrophy, and interstitial fibrosis via cross-talk between the endothelium and cardiomyocyte compartments. Here, we review the role of endothelial dysfunction and inflammation to explain the link between renal dysfunction and HFpEF, which allows for identification of new early risk markers, prognostic factors, and unique targets for intervention.

KEYWORDS:

Endothelial dysfunction; Heart failure with preserved ejection fraction; Inflammation; Renal dysfunction

PMID:
26861140
DOI:
10.1002/ejhf.497
[Indexed for MEDLINE]
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