Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, 20052, Monza, Italy.
Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
Heart Fail Rev. 2021 Jan;26(1):173-182. doi: 10.1007/s10741-019-09901-2.
Conclusive evidence demonstrates that the sympathetic nervous system activation is a hallmark of congestive heart failure. This has been shown via a variety of biochemical, neurophysiological, and neuroimaging approaches for studying human sympathetic neural function. The sympathetic activation appears to be an early phenomenon in the clinical course of the disease, closely related to its severity and potentiated by the concomitant presence of other comorbidities, such as obesity, diabetes mellitus, metabolic syndrome, hypertension, and renal failure. The adrenergic overdrive in heart failure is associated with other sympathetic abnormalities, such as the downregulation of beta-adrenergic adrenoreceptors at cardiac level, and exerts unfavorable consequences on the cardiovascular system. These include the endothelial dysfunction, the development of left ventricular hypertrophy, the atherosclerosis development, as well as the generation of atrial and ventricular arrhythmias, and, at very extreme levels of sympathetic activation, the occurrence of microscopic myocardial necrosis. Given the close direct independent relationships detected in heart failure between sympathetic activation and mortality, the adrenergic overdrive has become a target of neuromodulatory therapeutic interventions, which include non-pharmacological, pharmacological, and device-based interventions. For some of these approaches (specifically bilateral renal nerves ablation and carotid baroreceptor stimulation), additional studies are needed to better define their impact on the clinical course of the disease.
确凿的证据表明，交感神经系统的激活是充血性心力衰竭的一个标志。通过各种生化、神经生理学和神经影像学方法研究人类交感神经功能已经证明了这一点。交感神经的激活似乎是疾病临床过程中的早期现象，与疾病的严重程度密切相关，并因肥胖症、糖尿病、代谢综合征、高血压和肾衰竭等其他合并症的同时存在而加剧。心力衰竭中的肾上腺素能亢进与其他交感神经异常有关，例如心脏水平的β肾上腺素能肾上腺素受体下调，并对心血管系统产生不利影响。这些影响包括内皮功能障碍、左心室肥厚的发展、动脉粥样硬化的发展以及房性和室性心律失常的产生，并且在交感神经极度激活的情况下，还会发生微小的心肌坏死。鉴于在心力衰竭中检测到的交感神经激活与死亡率之间存在直接的密切关系，肾上腺素能亢进已成为神经调节治疗干预的目标，这些干预包括非药物、药物和基于设备的干预。对于其中一些方法（特别是双侧肾神经消融和颈动脉压力感受器刺激），需要进一步的研究来更好地确定它们对疾病临床过程的影响。
