Autonomic control of ventricular function in health and disease: current state of the art.
Autonomic control of ventricular function in health and disease: current state of the art.
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DOI：
10.1007/s10286-023-00948-8
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发表时间：
2023-08
影响因子：
5.8
通讯作者：
Vaseghi, Marmar
中科院分区：
文献类型：
--
作者：
van Weperen, Valerie Y. H.;Ripplinger, Crystal M.;Vaseghi, Marmar
心脏自主神经功能障碍是心血管病理生理学的主要支柱之一。本综述的目的是提供一个概述的心脏损伤和可用的神经调节治疗心力衰竭的自主神经功能障碍的自主神经系统内发生的病理性重塑的最新技术水平。 来自同行评议的出版物的数据在健康和心脏损伤后的自主神经功能进行审查。总结了各种神经调节疗法在临床前研究和临床实践中的作用和证据。 心脏和自主神经系统之间的和谐相互作用存在于神经轴的多个层次。这种相互作用在心血管疾病的背景下被破坏，导致多个水平的病理变化，从神经递质的亚细胞心脏信号传导到心脏外、胸外重塑。随后的交感迷走神经失衡的有害循环，其特征在于交感神经兴奋和副交感神经退缩，易于发生室性心律失常、心力衰竭进展和心脏性死亡。在过去的几十年里，关于这种疾病的病因学和病理生理学的知识呈指数级增长，从而产生了许多不同的神经调节方法。然而，在交感神经和副交感神经相互作用以及介导进行性交感神经兴奋和副交感神经功能障碍的因果因素方面仍然存在重大知识差距。尽管我们对心血管疾病中自主神经失衡的理解显著增加，但这种失衡的特定关键介质以及可用自主神经参数和神经调节疗法的认识和实施仍然滞后。
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.
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