NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom.
Int J Cardiol. 2013 Dec 10;170(2):107-17. doi: 10.1016/j.ijcard.2013.10.058. Epub 2013 Oct 25.
Neurohumoral activation, in which enhanced activity of the autonomic nervous system (ANS) is a key component, plays a pivotal role in heart failure. The neurohumoral system affects several organs and currently our knowledge of the molecular and systemic pathways involved in the neurohumoral activation is incomplete. All the methods of assessing the degree of activation of the autonomic system have limitations and they are not interchangeable. The methods considered include noradrenaline spillover, microneurography, radiotracer imaging and analysis of heart rate and blood pressure (heart rate variability, baroreceptor sensitivity, heart rate turbulence). Despite the difficulties, medications that affect the ANS have been shown to improve mortality in heart failure and the mechanism is related to attenuation of the sympathetic nervous system (SNS) and stimulation of the parasympathetic nervous system. However, limitations of compliance with medication, side effects and inadequate SNS attenuation are issues of concern with the pharmacological approach. The newer device based therapies for sympathetic modulation are showing encouraging results. As they directly influence the autonomic nervous system, more mechanistic information can be gleaned if appropriate investigations are performed at the time of the outcome trials. However, clinicians should be reminded that the ANS is an evolutionary survival mechanism and therefore there is a need to proceed with caution when trying to completely attenuate its effects. So our enthusiasm for the application of these devices in heart failure should be controlled, especially as none of the devices have trial data powered to assess effects on mortality or cardiovascular events.
神经体液激活，其中自主神经系统（ANS）的增强活动是一个关键组成部分，在心力衰竭中起着关键作用。神经体液系统影响多个器官，目前我们对涉及神经体液激活的分子和系统途径的了解并不完整。评估自主神经系统激活程度的所有方法都有其局限性，并且它们不可互换。被认为包括去甲肾上腺素溢出、微神经记录、放射性示踪成像以及心率和血压（心率变异性、压力感受器敏感性、心率震荡）的分析。尽管存在困难，但已证明影响 ANS 的药物可改善心力衰竭患者的死亡率，其机制与交感神经系统（SNS）的衰减和副交感神经系统的刺激有关。然而，药物治疗的依从性、副作用和 SNS 衰减不足等局限性是药物治疗方法关注的问题。用于交感神经调节的新型基于设备的治疗方法正在显示出令人鼓舞的结果。由于它们直接影响自主神经系统，如果在进行结果试验时进行适当的调查，可以获得更多的机制信息。然而，临床医生应注意，ANS 是一种进化生存机制，因此在试图完全衰减其作用时需要谨慎行事。因此，我们对这些设备在心力衰竭中的应用的热情应该得到控制，特别是因为没有任何设备具有试验数据来评估对死亡率或心血管事件的影响。
