Cardiac and renal function interactions in heart failure with reduced ejection fraction: A mathematical modeling analysis.
Benzhydryl Compounds
/ therapeutic use
Cardiomegaly
/ physiopathology
Extracellular Fluid
/ physiology
Glucosides
/ therapeutic use
Heart
/ physiopathology
Heart Failure
/ drug therapy
Hemodynamics
/ physiology
Humans
Kidney
/ physiopathology
Models, Cardiovascular
Myocytes, Cardiac
/ physiology
Sodium-Glucose Transporter 2 Inhibitors
/ therapeutic use
Stroke Volume
/ physiology
Journal
PLoS computational biology
ISSN: 1553-7358
Titre abrégé: PLoS Comput Biol
Pays: United States
ID NLM: 101238922
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
20
03
2020
accepted:
18
06
2020
revised:
27
08
2020
pubmed:
18
8
2020
medline:
12
9
2020
entrez:
18
8
2020
Statut:
epublish
Résumé
Congestive heart failure is characterized by suppressed cardiac output and arterial filling pressure, leading to renal retention of salt and water, contributing to further volume overload. Mathematical modeling provides a means to investigate the integrated function and dysfunction of heart and kidney in heart failure. This study updates our previously reported integrated model of cardiac and renal functions to account for the fluid exchange between the blood and interstitium across the capillary membrane, allowing the simulation of edema. A state of heart failure with reduced ejection fraction (HF-rEF) was then produced by altering cardiac parameters reflecting cardiac injury and cardiovascular disease, including heart contractility, myocyte hypertrophy, arterial stiffness, and systemic resistance. After matching baseline characteristics of the SOLVD clinical study, parameters governing rates of cardiac remodeling were calibrated to describe the progression of cardiac hemodynamic variables observed over one year in the placebo arm of the SOLVD clinical study. The model was then validated by reproducing improvements in cardiac function in the enalapril arm of SOLVD. The model was then applied to prospectively predict the response to the sodium-glucose co-transporter 2 (SGLT2) inhibitor dapagliflozin, which has been shown to reduce heart failure events in HF-rEF patients in the recent DAPAHF clinical trial by incompletely understood mechanisms. The simulations predict that dapagliflozin slows cardiac remodeling by reducing preload on the heart, and relieves congestion by clearing interstitial fluid without excessively reducing blood volume. This provides a quantitative mechanistic explanation for the observed benefits of SGLT2i in HF-rEF. The model also provides a tool for further investigation of heart failure drug therapies.
Identifiants
pubmed: 32804929
doi: 10.1371/journal.pcbi.1008074
pii: PCOMPBIOL-D-20-00461
pmc: PMC7451992
doi:
Substances chimiques
Benzhydryl Compounds
0
Glucosides
0
Sodium-Glucose Transporter 2 Inhibitors
0
dapagliflozin
1ULL0QJ8UC
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1008074Déclaration de conflit d'intérêts
No authors have competing interests.
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