The sympathetic nervous system in heart failure with preserved ejection fraction.

IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Joshua W-H Chang, Rohit Ramchandra
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引用次数: 0

Abstract

The sympathetic nervous system (SNS) is a major mediator of cardiovascular physiology during exercise in healthy people. However, its role in heart failure with preserved ejection fraction (HFpEF), where exercise intolerance is a cardinal symptom, has remained relatively unexplored. The present review summarizes and critically explores the currently limited data on SNS changes in HFpEF patients with a particular emphasis on caveats of the data and the implications for its subsequent interpretation. While direct measurements of SNS activity in HFpEF patients is scarce, modest increases in resting levels of muscle sympathetic nerve activity are apparent, although this may be due to the co-morbidities associated with the syndrome rather than HFpEF per se. In addition, despite some evidence for dysfunctional sympathetic signaling in the heart, there is no clear evidence for elevated cardiac sympathetic nerve activity. The lack of a compelling prognostic benefit with use of β-blockers in HFpEF patients also suggests a lack of sympathetic hyperactivity to the heart. Similarly, while renal and splanchnic denervation studies have been performed in HFpEF patients, there is no concrete evidence that the sympathetic nerves innervating these organs exhibit heightened activity. Taken together, the totality of data suggests limited evidence for elevated sympathetic nerve activity in HFpEF and that any SNS perturbations that do occur are not universal to all HFpEF patients. Finally, how the SNS responds during exertion in HFpEF patients remains unknown and requires urgent investigation.

射血分数保留型心力衰竭的交感神经系统。
交感神经系统(SNS)是健康人运动时心血管生理机能的主要介质。然而,交感神经系统在以运动不耐受为主要症状的射血分数保留型心力衰竭(HFpEF)中的作用却相对较少。本综述总结并批判性地探讨了目前有关 HFpEF 患者 SNS 变化的有限数据,并特别强调了数据的注意事项及其对后续解释的影响。虽然直接测量 HFpEF 患者交感神经活动的数据很少,但肌肉交感神经活动的静息水平明显略有增加,尽管这可能是由于与该综合征相关的并发症而非 HFpEF 本身所致。此外,尽管有证据表明心脏交感神经信号传导功能失调,但没有明确证据表明心脏交感神经活性升高。对高频低氧血症患者使用β-受体阻滞剂对预后没有明显的益处,这也表明心脏交感神经活性亢进。同样,虽然对 HFpEF 患者进行了肾脏和脾脏去神经化研究,但没有具体证据表明支配这些器官的交感神经表现出更高的活性。总之,所有数据都表明,HFpEF 患者交感神经活性升高的证据有限,而且任何确实发生的交感神经系统紊乱并不普遍适用于所有 HFpEF 患者。最后,HFpEF 患者的交感神经系统在劳累时如何反应仍是未知数,亟待研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Heart Failure Reviews
Heart Failure Reviews 医学-心血管系统
CiteScore
10.40
自引率
2.20%
发文量
90
审稿时长
6-12 weeks
期刊介绍: Heart Failure Reviews is an international journal which develops links between basic scientists and clinical investigators, creating a unique, interdisciplinary dialogue focused on heart failure, its pathogenesis and treatment. The journal accordingly publishes papers in both basic and clinical research fields. Topics covered include clinical and surgical approaches to therapy, basic pharmacology, biochemistry, molecular biology, pathology, and electrophysiology. The reviews are comprehensive, expanding the reader''s knowledge base and awareness of current research and new findings in this rapidly growing field of cardiovascular medicine. All reviews are thoroughly peer-reviewed before publication.
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