Pathophysiology of congestive heart failure

Pathophysiology of congestive heart failure (CHF) has undergone a remarkable evolution during the last two decades. CHF is now regarded especially as a neurohormonal disease and not only as a cardiocirculatory impairment. Many studies have emphasized that an abnormal neuroendocrine activation precedes the development of clinically recognized heart failure and plays an important pathogenetic role in progression of this disease. In patients with CHF, moreover, circulating levels of some neurohormonal factors have an independent negative prognostic value. More recently immunological and molecular biology studies have also demonstrated the negative effects exerted by some cytokines and by apoptosis. Correction of neurohormonal disorder is the rationale of therapeutical approach to patients with CHF and appears the only way to significantly decrease mortality. In this review the role of neuroendocrine activation in the pathophysiology of CHF is analyzed.