Author + information
- Received September 11, 2014
- Revision received November 19, 2014
- Accepted November 20, 2014
- Published online February 3, 2015.
- Petra Nijst, MD∗,†,
- Frederik H. Verbrugge, MD∗,†,
- Lars Grieten, PhD, MSc∗,†,
- Matthias Dupont, MD∗,
- Paul Steels, MD‡,
- W.H. Wilson Tang, MD§ and
- Wilfried Mullens, MD, PhD∗,‡∗ ()
- ∗Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- †Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- ‡Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- §Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- ↵∗Reprint requests and correspondence:
Dr. Wilfried Mullens, Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium.
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.
Drs. Nijst, Verbrugge, Grieten, and Mullens are researchers for the Limburg Clinical Research Program (LCRP), UHasselt-ZOL-Jessa, which is supported by the Foundation Limburg Sterk Merk (LSM), Hasselt University, Ziekenhuis Oost-Limburg, and Jessa Hospital. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 11, 2014.
- Revision received November 19, 2014.
- Accepted November 20, 2014.
- 2015 American College of Cardiology Foundation