Circulating paracrine and autocrine mechanisms in heart failure

Abstract

Evidence that neurohormonal mechanisms are implicated in the pathophysiology and progression of congestive heart failure is emerging. In addition to the circulatory factors, attention is being directed to factors which are synthesized and act locally at the tissue level to mediate the early compensatory and late decompensatory changes of cardiac remodeling, systemic vasoactivity, and salt and water homeostasis. The early stage of left ventricular dysfunction may be characterized by activation of circulatory and local vasodilatory-natriuretic-antimitogenic factors. These counter-regulatory systems sustain an asymptomatic stage of heart failure, which, for unknown reasons, is eventually overwhelmed by vasoconstrictor-antinatriuretic-mitogenic factors, resulting in overt, symptomatic congestive heart failure. This review highlights the recent evidence for a neurohormonal basis for the progression of heart failure.