Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, 20052 Monza, Italy.
Policlinico di Monza and University of Milano-Bicocca, Milan, Italy.
Cardiovasc Res. 2022 Jun 29;118(8):1857-1871. doi: 10.1093/cvr/cvab222.
The sympathetic nervous system overdrive occurring in heart failure has been reported for more than half a century. Refinements in the methodological approaches to assess human sympathetic neural function have allowed during recent years to better define various aspects related to the neuroadrenergic alteration. These include (i) the different participation of the individual regional sympathetic cardiovascular districts at the process, (ii) the role of the central nervous system in determining the neuroadrenergic overdrive, (iii) the involvement of baroreflex, cardiopulmonary reflex, and chemoreflex mechanisms in the phenomenon, which is also closely linked to inflammation and the immune reaction, (iv) the relationships with the severity of the disease, its ischaemic or idiopathic nature and the preserved or reduced left ventricular ejection fraction, and (v) the adverse functional and structural impact of the sympathetic activation on cardiovascular organs, such as the brain, the heart, and the kidneys. Information have been also gained on the active role exerted by the sympathetic activation on the disease outcome and its potential relevance as a target of the therapeutic interventions based on non-pharmacological, pharmacological, and invasive approaches, including the renal denervation, the splanchnic sympathetic nerve ablation, and the carotid baroreflex stimulation. The still undefined aspects of the neurogenic alterations and the unmet goals of the therapeutic approach having the sympathetic activation as a target of the intervention will be finally mentioned.
半个多世纪以来，人们一直报道心力衰竭时交感神经系统过度兴奋。近年来，评估人类交感神经功能的方法学方法不断改进，使人们能够更好地定义与神经递质改变相关的各个方面。这些方面包括：（i）个体区域交感心血管区在该过程中的不同参与；（ii）中枢神经系统在决定神经递质过度兴奋中的作用；（iii）压力反射、心肺反射和化学反射机制在该现象中的作用，该现象也与炎症和免疫反应密切相关；（iv）与疾病严重程度的关系、其缺血性或特发性性质以及左心室射血分数的保留或降低；（v）交感神经激活对心血管器官（如大脑、心脏和肾脏）的不良功能和结构影响。此外，人们还获得了关于交感神经激活对疾病结局的积极作用的信息，以及作为基于非药理学、药理学和介入性方法的治疗干预目标的潜在相关性，包括肾去神经支配、内脏交感神经消融和颈动脉压力反射刺激。最后将提到神经源性改变的未明方面以及将交感神经激活作为干预目标的治疗方法的未满足目标。
