Autonomic control of ventricular function in health and disease: current state of the art.
Autonomic
Heart failure
Parasympathetic
Sympathetic
Ventricular arrhythmias
Journal
Clinical autonomic research : official journal of the Clinical Autonomic Research Society
ISSN: 1619-1560
Titre abrégé: Clin Auton Res
Pays: Germany
ID NLM: 9106549
Informations de publication
Date de publication:
08 2023
08 2023
Historique:
received:
02
01
2023
accepted:
20
04
2023
medline:
21
8
2023
pubmed:
11
5
2023
entrez:
11
5
2023
Statut:
ppublish
Résumé
Cardiac autonomic dysfunction is one of the main pillars of cardiovascular pathophysiology. The purpose of this review is to provide an overview of the current state of the art on the pathological remodeling that occurs within the autonomic nervous system with cardiac injury and available neuromodulatory therapies for autonomic dysfunction in heart failure. Data from peer-reviewed publications on autonomic function in health and after cardiac injury are reviewed. The role of and evidence behind various neuromodulatory therapies both in preclinical investigation and in-use in clinical practice are summarized. A harmonic interplay between the heart and the autonomic nervous system exists at multiple levels of the neuraxis. This interplay becomes disrupted in the setting of cardiovascular disease, resulting in pathological changes at multiple levels, from subcellular cardiac signaling of neurotransmitters to extra-cardiac, extra-thoracic remodeling. The subsequent detrimental cycle of sympathovagal imbalance, characterized by sympathoexcitation and parasympathetic withdrawal, predisposes to ventricular arrhythmias, progression of heart failure, and cardiac mortality. Knowledge on the etiology and pathophysiology of this condition has increased exponentially over the past few decades, resulting in a number of different neuromodulatory approaches. However, significant knowledge gaps in both sympathetic and parasympathetic interactions and causal factors that mediate progressive sympathoexcitation and parasympathetic dysfunction remain. Although our understanding of autonomic imbalance in cardiovascular diseases has significantly increased, specific, pivotal mediators of this imbalance and the recognition and implementation of available autonomic parameters and neuromodulatory therapies are still lagging.
Identifiants
pubmed: 37166736
doi: 10.1007/s10286-023-00948-8
pii: 10.1007/s10286-023-00948-8
pmc: PMC10173946
doi:
Types de publication
Journal Article
Review
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
491-517Subventions
Organisme : NHLBI NIH HHS
ID : P01 HL141084
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL148190
Pays : United States
Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
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