The sympathetic/parasympathetic imbalance in heart failure with reduced ejection fraction

Floras, John S.
Ponikowski, Piotr

¹University Health Network and Mount Sinai Hospital Division of Cardiology, University of Toronto, Suite 1614, 600 University Avenue, Toronto, Ontario, Canada M5G 1X5
²Department for Heart Disease, Medical University, Clinical Military Hospital, Wroclaw, Poland

Corresponding author. Tel: +1 416 586 8704, Fax: +1 416 586 8702, Email: [email protected]

Received January 29, 2015

Received in revised form February 26, 2015

Accepted March 6, 2015

European Heart Journal 36(30):p 1974-1982, August 07, 2015. | DOI: 10.1093/eurheartj/ehv087

Cardiovascular autonomic imbalance, a cardinal phenotype of human heart failure, has adverse implications for symptoms during wakefulness and sleep; for cardiac, renal, and immune function; for exercise capacity; and for lifespan and mode of death. The objectives of this Clinical Review are to summarize current knowledge concerning mechanisms for disturbed parasympathetic and sympathetic circulatory control in heart failure with reduced ejection fraction and its clinical and prognostic implications; to demonstrate the patient-specific nature of abnormalities underlying this common phenotype; and to illustrate how such variation provides opportunities to improve or restore normal sympathetic/parasympathetic balance through personalized drug or device therapy.