期刊
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
卷 65, 期 4, 页码 378-388出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2014.11.025
关键词
endothelial dysfunction; endothelial glycocalyx; glycosaminoglycan; interstitium; proteoglycan
资金
- Foundation Limburg Sterk Merk (LSM)
- Hasselt University
- Ziekenhuis Oost-Limburg
- Jessa Hospital
The current understanding of heart failure (HF) does not fully explain the spectrum of HF symptoms. Most HF hospitalizations are related to sodium (Na+) and fluid retention resulting from neurohumoral up-regulation. Recent insights suggest that Na+ is not distributed in the body solely as a free cation, but that it is also bound to large interstitial glycosaminoglycan (GAG) networks in different tissues, which have an important regulatory function. In HF, high Na+ intake and neurohumoral alterations disrupt GAG structure, leading to loss of the interstitial buffer capacity and disproportionate interstitial fluid accumulation. Moreover, a diminished endothelial GAG network (the endothelial glycocalyx) results in increased vascular resistance and disturbed endothelial nitric oxide production. New imaging modalities can help evaluate interstitial Na+ and endothelial glycocalyx integrity. Furthermore, several therapies have been proven to stabilize interstitial GAG networks. Hence, a better appreciation of this new Na+ compartment might improve current management of HF. (C) 2015 by the American College of Cardiology Foundation.
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