Lymphatic Dysregulation in Patients With Heart Failure: JACC Review Topic of the Week

Marat Fudim; Husam M Salah; Janarthanan Sathananthan; Mathieu Bernier; Waleska Pabon-Ramos; Robert S Schwartz; Josep Rodés-Cabau; François Côté; Abubaker Khalifa; Sean A Virani; Manesh R Patel

doi:10.1016/j.jacc.2021.04.090

Lymphatic Dysregulation in Patients With Heart Failure: JACC Review Topic of the Week

J Am Coll Cardiol. 2021 Jul 6;78(1):66-76. doi: 10.1016/j.jacc.2021.04.090.

Authors

Affiliations

¹ Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA. Electronic address: marat.fudim@duke.edu.
² Department of Medicine, University of Arkansas for Medical Sciences, Arkansas, USA.
³ Centre for Cardiovascular Innovation and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
⁴ Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
⁵ Department of Radiology, Division of Interventional Radiology, Duke University Medical Center, Durham, North Carolina, USA.
⁶ Minneapolis Heart Institute, Minneapolis, Minnesota, USA.
⁷ Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Hospital Clinic of Barcelona, Barcelona, Spain.
⁸ Interventional Radiology Department, CHU de Quebec, Laval University, Quebec City, Quebec, Canada.
⁹ Department of Medicine, Joseph Brant Hospital, McMaster University, Hamilton, Ontario, Canada.
¹⁰ Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.

PMID: 34210416
DOI: 10.1016/j.jacc.2021.04.090

Abstract

The lymphatic system is an integral part of the circulatory system and plays an important role in the volume homeostasis of the human body. The complex anatomy and physiology paired with a lack of simple diagnostic tools to study the lymphatic system have led to an underappreciation of the contribution of the lymphatic system to acute and chronic heart failure (HF). Herein, we discuss the physiological role of the lymphatic system in volume management and the evidence demonstrating the dysregulation of the lymphatic system in HF. Further, we discuss the opportunity to target the lymphatic system in the management of HF and different potential approaches to accessing the lymphatic system.

Keywords: congestion; heart failure; lymphatic system.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Review

MeSH terms

Disease Management
Fluid Shifts / physiology
Heart Failure* / physiopathology
Heart Failure* / therapy
Humans
Lymphatic System / physiopathology*

Grants and funding

K23 HL151744/HL/NHLBI NIH HHS/United States