Clinical Cardiovascular Physiology Research Laboratory, University Health Network and Mount Sinai Hospital Division of Cardiology, Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada.
Clin Sci (Lond). 2021 Feb 26;135(4):651-669. doi: 10.1042/CS20201306.
The sympathetic nervous system coordinates the cardiovascular response to exercise. This regulation is impaired in both experimental and human heart failure with reduced ejection fraction (HFrEF), resulting in a state of sympathoexcitation which limits exercise capacity and contributes to adverse outcome. Exercise training can moderate sympathetic excess at rest. Recording sympathetic nerve firing during exercise is more challenging. Hence, data acquired during exercise are scant and results vary according to exercise modality. In this review we will: (1) describe sympathetic activity during various exercise modes in both experimental and human HFrEF and consider factors which influence these responses; and (2) summarise the effect of exercise training on sympathetic outflow both at rest and during exercise in both animal models and human HFrEF. We will particularly highlight studies in humans which report direct measurements of efferent sympathetic nerve traffic using intraneural recordings. Future research is required to clarify the neural afferent mechanisms which contribute to efferent sympathetic activation during exercise in HFrEF, how this may be altered by exercise training, and the impact of such attenuation on cardiac and renal function.
交感神经系统协调运动时的心血管反应。在实验性和射血分数降低的心力衰竭（HFrEF）中，这种调节都受到损害，导致交感神经兴奋状态，从而限制运动能力并导致不良后果。运动训练可以在休息时适度减轻交感神经兴奋。在运动过程中记录交感神经放电更加具有挑战性。因此，运动过程中获得的数据很少，结果也因运动方式而异。在这篇综述中，我们将：（1）描述实验性和人类 HFrEF 中各种运动模式下的交感活动，并考虑影响这些反应的因素；（2）总结运动训练对动物模型和人类 HFrEF 中静息和运动时交感传出的影响。我们将特别强调使用神经内记录报告传出交感神经活动的直接测量的人类研究。需要进一步的研究来阐明在 HFrEF 中运动时导致传出交感神经激活的神经传入机制，运动训练如何改变这种机制，以及这种衰减对心脏和肾功能的影响。
