NEUROMODULATION OF THE FAILING HEART: LOST IN TRANSLATION?
NEUROMODULATION OF THE FAILING HEART: LOST IN TRANSLATION?
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DOI：
10.1016/j.jacbts.2016.03.004
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发表时间：
2016-04
期刊：
影响因子：
--
通讯作者：
Mann DL
中科院分区：
文献类型：
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作者：
Byku M;Mann DL
交感迷走神经失衡导致心力衰竭（HF）进行性恶化，并与不良临床结局相关。基于支持自主调节在HF模型中的作用的令人信服的临床前研究，在射血分数降低的HF患者中使用脊髓刺激、迷走神经刺激和压力感受器激活治疗启动了一系列临床研究。尽管压力感受器激活疗法的II期研究仍然令人鼓舞，但脊髓刺激和迷走神经刺激的大型临床研究却产生了令人失望的结果。在这里，我们将重点关注支持神经调节在衰竭心脏中的作用的临床前研究，并对最近试图调节HF患者自主神经张力的临床试验进行了严格的审查。本综述将结束与翻译的自主神经系统的基于设备的调制从临床前模型到成功的临床试验的一些困难的分析，以及提供建议，如何推动神经调节领域的前进。
Sympathovagal imbalance contributes to progressive worsening of heart failure (HF) and is associated with untoward clinical outcomes. Based on compelling pre-clinical studies that supported the role of autonomic modulation in HF models, a series of clinical studies were initiated using spinal cord stimulation, vagus nerve stimulation, and baroreceptor activation therapy in patients with HF with a reduced ejection fraction. Whereas the phase II studies with baroreceptor activation therapy remain encouraging, the larger clinical studies with spinal cord stimulation and vagus nerve stimulation have yielded disappointing results. Here we will focus on the pre-clinical studies that supported the role of neuromodulation in the failing heart, as well provide a critical review of the recent clinical trials that have sought to modulate autonomic tone in HF patients. This review will conclude with an analysis of some of the difficulties in translating device-based modulation of the autonomic nervous system from pre-clinical models into successful clinical trials, as well as provide suggestions for how to move the field of neuromodulation forward.