Myocardial oedema: pathophysiological basis and implications for the failing heart

Data de publicação: 01/04/2022 Data Ahead of Print: 01/02/2022

Autores da FMUP

• Francisco Aguiar Vasques Novoa Faria

  Autor

• Rui João Gonçalves Cerqueira

  Autor

• Jennifer Mâncio Silva

  Autor

• Joaquim Adelino Correia Ferreira Leite Moreira

  Autor

• Roberto Liberal Fernandes Roncon Albuquerque

  Autor

Participantes de fora da FMUP

• Angélico-Gonçalves, A
• Alvarenga, JM
• Nobrega, J

Unidades de investigação

• Cirurgia e Fisiologia

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

Myocardial fluid homeostasis relies on a complex interplay between microvascular filtration, interstitial hydration, cardiomyocyte water uptake and lymphatic removal. Dysregulation of one or more of these mechanisms may result in myocardial oedema. Interstitial and intracellular fluid accumulation disrupts myocardial architecture, intercellular communication, and metabolic pathways, decreasing contractility and increasing myocardial stiffness. The widespread use of cardiac magnetic resonance enabled the identification of myocardial oedema as a clinically relevant imaging finding with prognostic implications in several types of heart failure. Furthermore, growing experimental evidence has contributed to a better understanding of the physical and molecular interactions in the microvascular barrier, myocardial interstitium and lymphatics and how they might be disrupted in heart failure. In this review, we summarize current knowledge on the factors controlling myocardial water balance in the healthy and failing heart and pinpoint the new potential therapeutic avenues.

© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Keywords

• Heart failure; Myocardial oedema; Cardiac microcirculation; Cardiac pericytes; Cardiac lymphatics; Myocardial interstitium; Extracellular matrix