Franklin Cardiovascular Assoc., PA and Autonomic Dysfunction and POTS Center, Sicklerville, NJ, USA.
Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, PA, USA.
Curr Cardiol Rep. 2022 Nov;24(11):1699-1709. doi: 10.1007/s11886-022-01781-7. Epub 2022 Sep 5.
Cardiovascular autonomic control is an intricately balanced dynamic process. Autonomic dysfunction, regardless of origin, promotes and sustains the disease processes, including in patients with heart failure (HF). Autonomic control is mediated through the two autonomic branches: parasympathetic and sympathetic (P&S). HF is arguably the disease that stands to most benefit from P&S manipulation to reduce mortality risk. This review article briefly summarizes some of the more common types of autonomic dysfunction (AD) that are found in heart failure, suggests a mechanism by which AD may contribute to HF, reviews AD involvement in common HF co-morbidities (e.g., ventricular arrhythmias, AFib, hypertension, and Cardiovascular Autonomic Neuropathy), and summarizes possible therapy options for treating AD in HF.
Autonomic assessment is important in diagnosing and treating CHF, and its possible co-morbidities. Autonomic assessment may also have importance in predicting which patients may be susceptible to sudden cardiac death. This is important since most CHF patients with sudden cardiac death have preserved left ventricular ejection fraction and better discriminators are needed. Many life-threatening cardiovascular disorders will require invasive testing for precise diagnoses and therapy planning when modulating the ANS is important. In cases of non-life-threatening disorders, non-invasive ANS testing techniques, especially those that individually assess both ANS branches simultaneously and independently, are sufficient to diagnose and treat serially.
心血管自主控制是一个错综复杂的平衡动态过程。自主功能障碍，无论起源如何，都促进和维持疾病进程，包括心力衰竭（HF）患者。自主控制通过两个自主分支介导：副交感神经和交感神经（P&S）。HF 可以说是从 P&S 操作中获益最大、降低死亡率风险的疾病。本文简要总结了心力衰竭中常见的一些自主神经功能障碍（AD）类型，提出了 AD 可能导致 HF 的机制，综述了 AD 与常见 HF 合并症（如室性心律失常、AFib、高血压和心血管自主神经病变）的关系，并总结了治疗 HF 中 AD 的可能治疗选择。
自主评估对诊断和治疗心力衰竭及其可能的合并症很重要。自主评估在预测哪些患者可能易患心脏性猝死方面也可能具有重要意义。这很重要，因为大多数心力衰竭伴心脏性猝死的患者左心室射血分数正常，需要更好的鉴别诊断。当调节自主神经系统很重要时，许多危及生命的心血管疾病将需要进行侵入性测试以进行精确诊断和治疗计划。在非危及生命的疾病情况下，非侵入性自主神经系统测试技术，尤其是那些可以同时独立评估两个自主神经系统分支的技术，足以进行诊断和连续治疗。
