Autonomic nervous system involvement in pulmonary arterial hypertension

Respiratory Research

Review

Shervin Sarji¹  Aman Mahajan¹  Pamela Chia¹  Nir Hoftman¹  Jason Nguyen¹  Gregoire Ruffenach¹  Mansoureh Eghbali¹  Soban Umar¹  Mylène Vaillancourt¹ 

[1] Department of Anesthesiology and Perioperative Medicine, Division of Molecular Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA), BH 520A CHS, Los Angeles, CA, USA;

关键词: Pulmonary arterial hypertension;    Autonomic nervous system;    Right ventricle;    Sympathetic nervous system;    Renin angiotensin aldosterone system;   

DOI  :  10.1186/s12931-017-0679-6

 received in 2017-04-03, accepted in 2017-11-13,  发布年份 2017

来源: Springer

【 摘 要 】

Pulmonary arterial hypertension (PAH) is a chronic pulmonary vascular disease characterized by increased pulmonary vascular resistance (PVR) leading to right ventricular (RV) failure. Autonomic nervous system involvement in the pathogenesis of PAH has been demonstrated several years ago, however the extent of this involvement is not fully understood. PAH is associated with increased sympathetic nervous system (SNS) activation, decreased heart rate variability, and presence of cardiac arrhythmias. There is also evidence for increased renin-angiotensin-aldosterone system (RAAS) activation in PAH patients associated with clinical worsening. Reduction of neurohormonal activation could be an effective therapeutic strategy for PAH. Although therapies targeting adrenergic receptors or RAAS signaling pathways have been shown to reverse cardiac remodeling and improve outcomes in experimental pulmonary hypertension (PH)-models, the effectiveness and safety of such treatments in clinical settings have been uncertain. Recently, novel direct methods such as cervical ganglion block, pulmonary artery denervation (PADN), and renal denervation have been employed to attenuate SNS activation in PAH. In this review, we intend to summarize the multiple aspects of autonomic nervous system involvement in PAH and overview the different pharmacological and invasive strategies used to target autonomic nervous system for the treatment of PAH.

【 授权许可】

CC BY   
© The Author(s). 2017