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(Referência obtida automaticamente do Web of Science, por meio da informação sobre o financiamento pela FAPESP e o número do processo correspondente, incluída na publicação pelos autores.)

Contribution of Autonomic Reflexes to the Hyperadrenergic State in Heart Failure

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Autor(es):
Toschi-Dias, Edgar ; Rondon, Maria Urbana P. B. ; Cogliati, Chiara ; Paolocci, Nazareno ; Tobaldini, Eleonora ; Montano, Nicola
Número total de Autores: 6
Tipo de documento: Artigo de Revisão
Fonte: FRONTIERS IN NEUROSCIENCE; v. 11, MAR 30 2017.
Citações Web of Science: 7
Resumo

Heart failure (HF) is a complex syndrome representing the clinical endpoint of many cardiovascular diseases of different etiology. Given its prevalence, incidence and social impact, a better understanding of HF pathophysiology is paramount to implement more effective anti-HF therapies. Based on left ventricle (LV) performance, HF is currently classified as follows: (1) with reduced ejection fraction (HFrEF);(2) with mid-range EF (HFmrEF); and (3) with preserved EF (HFpEF). A central tenet of HFrEF pathophysiology is adrenergic hyperactivity, featuring increased sympathetic nerve discharge and a progressive loss of rhythmical sympathetic oscillations. The role of reflex mechanisms in sustaining adrenergic abnormalities during HFrEF is increasingly well appreciated and delineated. However, the same cannot be said for patients affected by HFpEF or HFmrEF, whom also present with autonomic dysfunction. Neural mechanisms of cardiovascular regulation act as ``controller units,{''} detecting and adjusting for changes in arterial blood pressure, blood volume, and arterial concentrations of oxygen, carbon dioxide and pH, as well as for humoral factors eventually released after myocardial (or other tissue) ischemia. They do so on a beat-to-beat basis. The central dynamic integration of all these afferent signals ensures homeostasis, at rest and during states of physiological or pathophysiological stress. Thus, the net result of information gathered by each controller unit is transmitted by the autonomic branch using two different codes: intensity and rhythm of sympathetic discharges. The main scope of the present article is to (i) review the key neural mechanisms involved in cardiovascular regulation; (ii) discuss how their dysfunction accounts for the hyperadrenergic state present in certain forms of HF; and (iii) summarize how sympathetic efferent traffic reveal central integration among autonomic mechanisms under physiological and pathological conditions, with a special emphasis on pathophysiological characteristics of HF. (AU)

Processo FAPESP: 15/17642-0 - Um sistema múltiplo de abordagem fisiopatológica para a insuficiência cardíaca com fração de ejeção preservada em idosos: em busca de novas estratégias terapêuticas
Beneficiário:Edgar Toschi Dias
Linha de fomento: Bolsas no Exterior - Estágio de Pesquisa - Pós-Doutorado
Processo FAPESP: 13/07651-7 - Valor prognóstico do padrão oscilatório da atividade nervosa simpática muscular em pacientes com insuficiência cardíaca
Beneficiário:Edgar Toschi Dias
Linha de fomento: Bolsas no Brasil - Pós-Doutorado