Sympathetic nervous system, systolic heart failure, and central sleep apnea: Are we about to find the missing link?

Excerpt

Sympathetic nervous system (SNS) activation has long been known to be a cardinal feature in the pathophysiology of cardiac remodeling and systolic heart failure (SHF). It was reported to have implications for both disease progression and survival. SNS activation is assumed to be secondary to the decrease of sympatho-inhibitory reflexes usually drove by the stimulation of afferent mechanoreceptors and by the increase of efferent sympatho-excitatory mechanisms associated with alteration in autonomic regulation.1 Activation of cardiac and peripheral sympathetic nervous systems has been linked to the rate of disease progression and sudden death.2 The main retrospective and prospective studies have shown that cardiac neuronal uptake based on Heart-Mediastinum Ratio (HMR) by ¹²³I-Metaiodobenzylguanidine (MIBG) imaging was a prognostic indicator of severe heart failure and/or ventricular arrhythmia if HMR was less than 1.6 in patients with a left ventricular ejection fraction less than 35%.3-5 These findings have been the rationale for the use of beta-adrenergic blocking agents in the management of patients with SHF. …