A Systematic Review Concerning the Relation between the Sympathetic Nervous System and Heart Failure with Preserved Left Ventricular Ejection Fraction

Verloop, Willemien L.; Beeftink, Martine M.A.; Santema, Bernadet T.; Bots, Michiel L.; Blankestijn, Peter J.; Cramer, Maarten J.; Doevendans, Pieter A.; Voskuil, Michiel

doi:10.1371/journal.pone.0117332

Cited by 51 publications

(49 citation statements)

References 73 publications

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“…Our present findings may be the result of the activation of the sympathetic nervous system. The riser BP pattern is caused by autonomic nervous system dysfunction, and activation of the sympathetic nervous system has been observed in HFpEF . Therefore, sympathetic nervous system activation in HFpEF is one of the causes of the riser BP pattern.…”

Section: Discussionmentioning

confidence: 99%

Riser Pattern: Another Determinant of Heart Failure With Preserved Ejection Fraction

Komori

Eguchi

Saito

et al. 2016

J of Clinical Hypertension

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Paradoxical increase in blood pressure (BP) during sleep, exceeding those of awake BP, is called the “riser” BP pattern, and known as an abnormal circadian BP rhythm, has been reported to be associated with adverse cardiovascular prognoses. However, the significance of ambulatory BP in heart failure patients with preserved ejection fraction (HFpEF) has never been reported. Here, we tested our hypothesis that abnormal circadian BP rhythm is associated with HFpEF. The authors enrolled 508 patients with hospitalized HF (age 68±13 years; 315 men, 193 women). There were 232 cases of HFpEF and 276 cases of heart failure with reduced ejection fraction (HFrEF). The riser BP pattern was significantly more frequent in the HFpEF (28.9%) group compared with the HFrEF group (19.9%). In a multivariable logistic regression analysis, the riser BP pattern was associated with HFpEF (odds ratio, 1.73; 95% confidence interval, 1.02–2.91; P=.041) independent of the other covariates. In conclusion, the riser BP pattern was associated with HFpEF.

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Section: Discussionmentioning

confidence: 99%

Riser Pattern: Another Determinant of Heart Failure With Preserved Ejection Fraction

Komori

Eguchi

Saito

et al. 2016

J of Clinical Hypertension

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“…Sympathetic overdrive has been documented in these patients as well. Verloop and colleagues recently concluded that the current availability of knowledge does not permit a distinguishment on whether enhanced sympathetic activity results in HFpEF, or HFpEF results in enhanced sympathetic activity (Verloop et al, 2015). Moreover, whether patients with HFmrEF present with a hyperadrenergic state, and the eventual magnitude of this alteration, remains to be documented clinically.…”

Section: Hyperadrenergic State In Heart Failurementioning

confidence: 99%

“…However, substantial efforts are needed to identify changes in neural-cardiovascular regulatory pathways in HFpEF patients. Indeed, these patients also have prominent autonomic dysfunction (Verloop et al, 2015). However, little is known about the role of neural mechanisms that govern the amplitude or frequency of bursts of autonomic activity, or the pattern of active fiber discharge.…”

Section: Introductionmentioning

confidence: 99%

Contribution of Autonomic Reflexes to the Hyperadrenergic State in Heart Failure

et al. 2017

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Heart failure (HF) is a complex syndrome representing the clinical endpoint of many cardiovascular diseases of different etiology. Given its prevalence, incidence and social impact, a better understanding of HF pathophysiology is paramount to implement more effective anti-HF therapies. Based on left ventricle (LV) performance, HF is currently classified as follows: (1) with reduced ejection fraction (HFrEF); (2) with mid-range EF (HFmrEF); and (3) with preserved EF (HFpEF). A central tenet of HFrEF pathophysiology is adrenergic hyperactivity, featuring increased sympathetic nerve discharge and a progressive loss of rhythmical sympathetic oscillations. The role of reflex mechanisms in sustaining adrenergic abnormalities during HFrEF is increasingly well appreciated and delineated. However, the same cannot be said for patients affected by HFpEF or HFmrEF, whom also present with autonomic dysfunction. Neural mechanisms of cardiovascular regulation act as “controller units,” detecting and adjusting for changes in arterial blood pressure, blood volume, and arterial concentrations of oxygen, carbon dioxide and pH, as well as for humoral factors eventually released after myocardial (or other tissue) ischemia. They do so on a beat-to-beat basis. The central dynamic integration of all these afferent signals ensures homeostasis, at rest and during states of physiological or pathophysiological stress. Thus, the net result of information gathered by each controller unit is transmitted by the autonomic branch using two different codes: intensity and rhythm of sympathetic discharges. The main scope of the present article is to (i) review the key neural mechanisms involved in cardiovascular regulation; (ii) discuss how their dysfunction accounts for the hyperadrenergic state present in certain forms of HF; and (iii) summarize how sympathetic efferent traffic reveal central integration among autonomic mechanisms under physiological and pathological conditions, with a special emphasis on pathophysiological characteristics of HF.

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“…4) Therapeutic targeting to block excessive sympathetic activation in HF could reduce morbidity and mortality. 5) While numerous types of inhibition of sympathetic activity are being investigated, renal sympathetic denervation (RDN) is an interventional treatment option for patients.…”

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confidence: 99%

Influence of Renal Sympathetic Denervation in Patients with Early-Stage Heart Failure Versus Late-Stage Heart Failure

et al. 2018

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SummaryRenal sympathetic denervation (RDN) is currently being investigated in multiple studies of heart failure (HF). Our aim was to assess the safety and effectiveness of RDN in patients with HF, and determine which patients could achieve more beneficial effects of RDN. A total of 17 consecutive patients with HF were enrolled in the study. Clinical symptoms, office blood pressure, and laboratory results were obtained and echocardiography was performed before and 12 months after RDN. Changes from baseline to 12 months were analyzed for all patients and for two subgroups based on HF duration (group 1: HF duration !3 years, n = 9; group 2: HF duration > 3 years, n = 8). The RDN procedure was successful in all patients and no procedure-related complications were documented. In comparison to baseline, there was a significant increase in left ventricular ejection fraction (LVEF) in all patients and group 1 (P < 0.05 for both), which did not happen in group 2. LAD, LVDs, and RVD also showed a significant reduction in group 1 (P < 0.05 for both). At 12 months, the reductions in TNF-α and CRP were significant for all patients and for patients in group 1 separately. No obvious changes in echocardiographic parameters, 6-minute walking distance, TNF-α, or CRP were recorded in group 2. No changes in BNP in either group were observed at the 12th month of follow-up. RDN could improve cardiac function and led to a significant drop in inflammatory markers in patients with HF. We also found that patients in early-stage HF could benefit more from RDN.(Int Heart J 2018; 59: 99-104)

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A Systematic Review Concerning the Relation between the Sympathetic Nervous System and Heart Failure with Preserved Left Ventricular Ejection Fraction

Cited by 51 publications

References 73 publications

Riser Pattern: Another Determinant of Heart Failure With Preserved Ejection Fraction

Riser Pattern: Another Determinant of Heart Failure With Preserved Ejection Fraction

Contribution of Autonomic Reflexes to the Hyperadrenergic State in Heart Failure

Influence of Renal Sympathetic Denervation in Patients with Early-Stage Heart Failure Versus Late-Stage Heart Failure

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