Hyperammonemia and Chronic Heart Failure: the Relationship and Approaches to Solving the Problem

Aim. To consider modern views on risk factors and progression of chronic heart failure (CHF), the main causes of hyperammonemia, the clinical and pathogenetic relationship of hyperammonemia and CHF and approaches to patient management.

Key points. CHF is one of the leading cardiovascular problems today. The prevalence of CHF varies from 0.3% in people aged 20–29 years to 70% in people over 90 years old. In the case of progressive HF, it may be necessary to have a heart transplant or long-term mechanical circulatory support, as well as palliative care, which also requires significant costs. Heart failure with preserved left ventricular ejection fraction (accounts for about 50% of all CHF cases. An increase in the ammonia content in the blood causes a high probability of developing multiorgan dysfunction. Reference levels of ammonia levels in human blood are not definitively regulated by international documents. The normal values mainly depend on the technique and the reagents used. The formation of hyperammonemia is a multifactorial process. The main causes are liver malfunction. In the structure of all causes of hyperammonemia, the proportion of the liver cirrhosis is about 90%, and non-cirrhotic causes — about 10%. Many mechanisms of non-cirrhotic hyperammonemia have been described. Non-cirrhotic hyperammonemia may be the result of increased pressure in the hepatic veins, which can lead to damage to hepatocytes and an increase in serum ammonia levels. To date, researchers are particularly interested in the development of hyperammonemia against the background of taking anticonvulsants. Under the influence of ammonia, the expression of myostatin increases, which reduces the growth of muscle mass, at the same time, muscle proteolysis is activated. Since the myocardium is a muscle tissue, similar processes in cardiomyocytes are not excluded. It has been proven that patients with HF have higher ammonia levels than those without it. The use of L-ornithine-L-aspartate is one of the main strategies for the correction of hyperammonemia.

Conclusion. At the moment, there is a need for further study of the combination of CHF and hyperammonemia, the mechanisms of mutual influence, as well as risk factors for the progression of CHF against the background of hyperammonemia and the problem of managing such patients.

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