Autonomic Dysregulation as a Therapeutic Target for Acute HF

Abstract

Despite major advances that have led to effective therapeutic modalities for the treatment of heart failure (HF), this syndrome has continued to be a staggering health problem associated with significant mortality and morbidity. The increasing number of hospital admissions and readmissions related to acute HF continues to pose a fiscal challenge leading to constant interest in development of novel approaches. These point to multiple areas of unmet needs especially in acute HF, thus, necessitating further efforts to develop novel strategies for prevention and treatment of acute HF. One area of continuing focus is targeting the role of autonomic imbalance associated with the development of HF. Autonomic dysregulation, manifested by increased sympathetic drive and reduced parasympathetic activity, has been recognized as a mediator of increased mortality and morbidity in HF and myocardial infarction. Furthermore, vagal withdrawal has been shown to precede acute decompensation, though whether this represents cause or effect is unknown. This review discusses the potential role of autonomic dysregulation as a therapeutic modality for patients with acute decompensated HF.

Pharmacological Modulation of Vagal Nerve Activity in Cardiovascular Diseases

“…An imbalance in the ANS is a predictor for a negative prognosis in patients with HF. It has been demonstrated that decreased vagal tone is associated with an increase in mortality for HF [ 28 ]. A recent report indicates that the neurotransmitter response of the cardiac vagal neurons in the brain stem is altered [ 29 ].…”