Cardiac innervation and sudden cardiac death.
Cardiac innervation and sudden cardiac death.
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DOI：
10.1161/circresaha.116.304679
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发表时间：
2015-06-05
影响因子：
20.1
通讯作者：
Shivkumar K
中科院分区：
文献类型：
--
作者：
Fukuda K;Kanazawa H;Aizawa Y;Ardell JL;Shivkumar K
通过心脏神经的传入和传出心脏神经传递复杂地调节心脏的几乎所有生理功能（变时性、变频性、收缩性和变力性）。来自心脏的传入信息被传输到神经系统的更高水平以进行处理（内在心脏神经系统、心外-胸内神经节、脊髓、脑干和更高的中心），这最终导致传出心脏神经冲动（经由交感神经和副交感神经）。该系统形成相互作用的反馈回路，提供生理稳定性以维持正常节律和维持生命的循环。该系统还确保在正常和应激状态下，在短期（心跳到心跳），中期（分钟-小时）和长期（天-年）中对心脏中的交感神经-副交感神经平衡进行微调调节。这种重要的神经内脏/自主神经系统也在心脏病的病理生理学和进展中发挥重要作用，包括心力衰竭和导致心源性猝死（SCD）的心律失常。心力衰竭、功能性去神经支配、心脏和心脏外神经重塑中的神经元转分化也已在疾病进展期间被鉴定和表征。最近在了解健康和疾病中控制神经支配和心肌功能控制的细胞和分子过程方面取得的进展，为开发预防SCD和其他心律失常的神经轴疗法提供了合理的机制基础。细胞、分子和生物工程领域的进展强调了这一领域作为科学探究和治疗干预的重要途径的出现。
Afferent and efferent cardiac neurotransmission via the cardiac nerves intricately modulates nearly all physiological functions of the heart (chronotropy, dromotropy, lusitropy and inotropy). Afferent information from the heart is transmitted to higher levels of the nervous system for processing (intrinsic cardiac nervous system, extracardiac-intrathoracic ganglia, spinal cord, brain stem and higher centers) which ultimately results in efferent cardiomotor neural impulses (via the sympathetic and parasympathetic nerves). This system forms interacting feedback loops that provide physiological stability for maintaining normal rhythm and life-sustaining circulation. This system also ensures that there is fine-tuned regulation of sympathetic-parasympathetic balance in the heart under normal and stressed states in the short (beat to beat), intermediate (minutes-hours) and long term (days-years). This important neurovisceral /autonomic nervous system also plays a major role in the pathophysiology and progression of heart disease, including heart failure and arrhythmias leading to sudden cardiac death (SCD). Transdifferentiation of neurons in heart failure, functional denervation, cardiac and extra-cardiac neural remodeling have also been identified and characterized during the progression of disease. Recent advances in understanding the cellular and molecular processes governing innervation and the functional control of the myocardium in health and disease provides a rational mechanistic basis for development of neuraxial therapies for preventing SCD and other arrhythmias. Advances in cellular, molecular, and bioengineering realms have underscored the emergence of this area as an important avenue of scientific inquiry and therapeutic intervention.