Cardiovascular Section, Department of Internal Medicine, Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Cardiovascular Section, Department of Internal Medicine, Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Life Sci. 2023 Nov 15;333:122122. doi: 10.1016/j.lfs.2023.122122. Epub 2023 Sep 28.
Abnormal cardiac metabolism or cardiac metabolic remodeling is reported before the onset of heart failure with reduced ejection fraction (HFrEF) and is known to trigger and maintain the mechanical dysfunction and electrical, and structural abnormalities of the ventricle. A dysregulated cardiac autonomic tone characterized by sympathetic overdrive with blunted parasympathetic activation is another pathophysiological hallmark of HF. Emerging evidence suggests a link between autonomic nervous system activity and cardiac metabolism. Chronic β-adrenergic activation promotes maladaptive metabolic remodeling whereas cholinergic activation attenuates the metabolic aberrations through favorable modulation of key metabolic regulatory molecules. Restoration of sympathovagal balance by neuromodulation strategies is emerging as a novel nonpharmacological treatment strategy in HF. The current review attempts to evaluate the 'neuro-metabolic axis' in HFrEF and whether neuromodulation can mitigate the adverse metabolic remodeling in HFrEF.
异常的心脏代谢或心脏代谢重构在射血分数降低的心力衰竭（HFrEF）发病前就有报道，已知它会引发和维持心室的机械功能障碍以及电和结构异常。心脏自主神经张力失调的特征是交感神经亢进伴副交感神经激活迟钝，这是心力衰竭的另一个病理生理标志。新出现的证据表明自主神经系统活动与心脏代谢之间存在联系。慢性β-肾上腺素能激活促进适应性代谢重构，而胆碱能激活通过对关键代谢调节分子的有利调节来减轻代谢异常。通过神经调节策略恢复交感神经和副交感神经的平衡，正在成为心力衰竭的一种新的非药物治疗策略。目前的综述试图评估 HFrEF 中的“神经代谢轴”，以及神经调节是否可以减轻 HFrEF 中的不良代谢重构。
