Can the speed at which lymph flows through the lower extremities predict the effectiveness of heart failure treatment? A team of researchers Barbara Ponikowska, Robert Zymliński, Marat Fudim , Beata Ponikowska, Gracjan Iwanek , Mateusz Guzik, Jan Biegusfrom the Wroclaw University of Medical Sciences, Uniwersytecki Szpital Kliniczny im. Jana Mikulicza-Radeckiego we Wrocławiu, and Duke University indicates that yes.
In a study Lower extremity lymphatic flow is associated with diuretic response in acute heart failure published in the European Journal of Heart Failure, researchers have shown that in patients with acute heart failure, there is a correlation between the efficiency of lymphatic flow in the lower extremities and responsiveness to treatment with diuretics (dehydrating drugs). The study used an advanced indocyanine green lymphography method to track real-time lymph flow.
The results are unequivocal: patients whose lymph reached a greater distance in a shorter time had significantly better treatment outcomes. Moreover, lymph flow proved to be an independent predictor of treatment efficacy – more significant than the level of creatinine or the cardiac-produced biomarker NT-proBNP used to date.
– In our study, we showed that rapid lymph flow in the lower extremities is associated with a better response to diuretic treatment. For the first time, we were able to show that a smoothly functioning lymphatic system plays an important role in the drainage process of a patient with acute heart failure,” stresses Professor Jan Biegus of the Institute of Heart Disease at the Medical University of Wroclaw.
The study used an objective diuresis treatment protocol and measured lymph flow using a fluorescent dye. Patients whose lymph traveled a greater distance quickly had significantly higher diuresis – meaning more efficient drainage of excess fluid from the swollen tissue.
– We suspect that insufficiency of the lymphatic system may hinder the effective action of diuretics, as the body defends itself against excessive fluid loss from the plasma when it is not adequately replenished from the interstitial space (for which the lymphatic system is responsible). The role of efficient lymphatic drainage may be crucial here, adds Prof. Biegus.
The researchers believe their discovery could pave the way for new therapeutic strategies in the future – such as supporting the lymphatic system in patients with refractory heart failure.
From a clinical perspective, this could mean that future therapies to promote lymphatic outflow may improve the effectiveness of standard treatment. This opens a whole new chapter in our understanding of the pathophysiology of heart failure,” Barbara Ponikowska of the Medical University of Wroclaw points out.
The study was conducted among 65 patients with AHF. 66% of them had a good response to treatment. In this group, lymph flow was significantly faster and more extensive than those who responded less well to treatment.
This material is based on an article:
Lower extremity lymphatic flow is associated with diuretic response in acute heart failure.
European Journal of Heart Failure
Authors: Barbara Ponikowska, Robert Zymliński, Marat Fudim, Beata Ponikowska, Gracjan Iwanek, Mateusz Guzik, Jan Biegus
Doi: https://doi.org/10.1002/ejhf.3655
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