title: The sympathetic/parasympathetic imbalance in heart failure with reduced ejection fraction.
abstract: 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.
authors.affiliation: University Health Network and Mount Sinai Hospital Division of Cardiology, University of Toronto, Suite 1614, 600 University Avenue, Toronto, Ontario, Canada M5G 1X5 john.floras@utoronto.ca.
authors.forename: John S
authors.initials: JS
authors.lastname: Floras
authors.affiliation: Department for Heart Disease, Medical University, Clinical Military Hospital, Wroclaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
mesh_terms: D000344:Afferent Pathways / Q000502:physiology; D001342:Autonomic Nervous System Diseases / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D017704:Baroreflex / Q000502:physiology; D015415:Biomarkers / Q000378:metabolism; D002493:Central Nervous System Diseases / Q000150:complications / Q000503:physiopathology; D002628:Chemoreceptor Cells / Q000502:physiology; D006333:Heart Failure / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007668:Kidney / Q000294:innervation; D008465:Mechanoreceptors / Q000502:physiology; D018482:Muscle, Skeletal / Q000502:physiology; D011379:Prognosis; D012893:Sleep Wake Disorders / Q000209:etiology / Q000503:physiopathology; D013318:Stroke Volume / Q000502:physiology
chemical_list: D015415:Biomarkers
keywords: Baroreceptor reflex; Chemoreceptor reflex; Exercise; Heart failure; Human; Parasympathetic nervous system; Sleep apnoea; Sympathetic nervous system