Splanchnic Circulation Dynamics in Heart Failure
Summary
The splanchnic circulation, comprising the vascular network serving the gastrointestinal tract, liver, spleen and pancreas, acts as a major blood reservoir and regulator of venous return. In healthy individuals, dynamic modulation of splanchnic vascular tone and capacitance buffers abrupt changes in cardiac preload, supports exercise tolerance and maintains central haemodynamics. Heart failure disrupts these compensatory mechanisms through chronic neurohormonal activation, leading to persistent splanchnic vasoconstriction, elevated venous pressures and impaired regional perfusion. The resulting congestion in the abdominal organs exacerbates systemic fluid overload, contributes to gut barrier dysfunction and fuels low-grade inflammation. Additionally, maladaptive remodelling of the lymphatic network in the splanchnic bed diminishes interstitial fluid clearance and aggravates oedema. A deeper understanding of the interplay between splanchnic blood volume shifts, lymphatic drainage and central haemodynamic load is now informing novel therapeutic approaches. These include pharmacological agents that selectively dilate the splanchnic venous reservoir, device-based modulators of regional vascular tone and interventions to restore lymphatic flow, all of which hold promise for more precise management of congestion in heart failure.
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Splanchnic Circulation Dynamics in Heart Failure publication trend
The graph below shows the total number of articles in splanchnic circulation dynamics in heart failure across all publications each year (not limited to Nature Index journals).
Technical terms
Splanchnic circulation: The network of arteries and veins supplying and draining the abdominal viscera, acting as a key blood reservoir and modulator of venous return to the heart.
Venous capacitance: The ability of a venous bed to expand and accommodate changes in blood volume, thereby regulating preload and central venous pressure.
Interstitial decongestion: The removal of excess fluid from the tissue spaces, particularly through lymphatic pathways, to reduce oedema and relieve organ congestion.
Thoracic duct: The main lymphatic vessel that collects lymph from the splanchnic and peripheral tissues and empties it into the central venous circulation, primarily at the junction of the left subclavian and internal jugular veins.
Central venous pressure: The pressure within the thoracic vena cava near the right atrium, reflecting the balance between venous return and right ventricular function.
References
- Mechanized lymphatic drainage in acute decompensated heart failure. A study on a hydrodynamic test bench. Russian Journal of Transplantology and Artificial Organs (2022).
- The interstitial compartment as a therapeutic target in heart failure. Frontiers in Cardiovascular Medicine (2022).
- Novel Therapeutic Devices in Heart Failure. Journal of Clinical Medicine (2022).
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