Increased sympathetic nerve activation is related to heart failure with preserved left ventricular ejection fraction, likely operating as a vicious circle where they sustain each other.
Systematic Review
Is increased sympathetic nerve activation related to the development of heart failure with preserved ejection fraction (HFPEF)?
This systematic review confirms a relationship between increased sympathetic nerve activation and HFPEF, suggesting a vicious cycle where both conditions sustain each other.
BACKGROUND: Heart failure with preserved left ventricular ejection fraction (HFPEF) affects about half of all patients diagnosed with heart failure. The pathophysiological aspect of this complex disease state has been extensively explored, yet it is still not fully understood. Since the sympathetic nervous system is related to the development of systolic HF, we hypothesized that an increased sympathetic nerve activation (SNA) is also related to the development of HFPEF. This review summarizes the available literature regarding the relation between HFPEF and SNA. METHODS AND RESULTS: Electronic databases and reference lists through April 2014 were searched resulting in 7722 unique articles. Three authors independently evaluated citation titles and abstracts, resulting in 77 articles reporting about the role of the sympathetic nervous system and HFPEF. Of these 77 articles, 15 were included for critical appraisal: 6 animal and 9 human studies. Based on the critical appraisal, we selected 9 articles (3 animal, 6 human) for further analysis. In all the animal studies, isoproterenol was administered to mimic an increased sympathetic activity. In human studies, different modalities for assessment of sympathetic activity were used. The studies selected for further evaluation reported a clear relation between HFPEF and SNA. CONCLUSION: Current literature confirms a relation between increased SNA and HFPEF. However, current literature is not able to distinguish whether enhanced SNA results in HFPEF, or HFPEF results in enhanced SNA. The most likely setting is a vicious circle in which HFPEF and SNA sustain each other.
Verloop et al. (Fri,) conducted a systematic review in Heart Failure with Preserved Left Ventricular Ejection Fraction (HFPEF). Sympathetic nerve activation (SNA) vs. Normal sympathetic activity / Controls was evaluated on Relationship between sympathetic nerve activation and HFPEF. Increased sympathetic nerve activation is related to heart failure with preserved left ventricular ejection fraction, likely operating as a vicious circle where they sustain each other.
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