26/02/2021
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Lymphatics and Your Heart
More than 300 years ago Rudbeck described the (subepicardial) lymphatic of the heart.
These vessels are extremely important for your heart health albeit their function is not completely understood.
In the heart, reduced lymphatic function can lead to myocardial oedema and persistent inflammation.
Myocardial infarction (MI) is currently a major cause of mortality worldwide, and there are no good treatments currently available to revert the damages of MI.
Lymphatic role in removal of extravasated fluids from the interstitial compartment is critical in the heart. For example, a 3.5% increase in myocardial fluids can lead to a 40% reduction in cardiac output.
After myocardial ischemia in humans, the heart cannot regenerate but remodels in an attempt to compensate for the loss of cardiovascular tissue, and healing occurs by replacing the dead myocardium with scar tissue.
In this case, the cardiac lymphatics undergo lymphangiogenesis by growing and expanding in the infarcted area.
Unfortunately, the lack of external compression by the heart makes the lymph vessels function insufficient to clear the myocardial oedema and the infiltrated immune cells after MI.
The increase in interstitial pressure, combined with the loss of myocardium, eventually leads to fibrosis, impaired heart function and ultimately heart failure.
Augmentation of the lymphangiogenic response with administration of specific substances has been shown to improve cardiac function after MI in animal models.
Research on the lymphatic vessels as a potential therapeutic target to reduce myocardial oedema and modulate the immune response after myocardial infarction (MI) are receiving increased attention.
Klaourakis K, Vieira J, Riley P. The evolving cardiac lymphatic vasculature in development, repair and regeneration. Nat Rev Cardiol. 2021 Jan 18 : 1–12.