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      The autonomic nervous system as a therapeutic target in heart failure: a scientific position statement from the Translational Research Committee of the Heart Failure Association of the European Society of Cardiology : Autonomic nervous system therapy in HF

      1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 6 , 6 , 22 , 18 , 19 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 2 , 3
      European Journal of Heart Failure
      Wiley

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          Abstract

          <p class="first" id="d4219686e582">Despite improvements in medical therapy and device-based treatment, heart failure (HF) continues to impose enormous burdens on patients and health care systems worldwide. Alterations in autonomic nervous system (ANS) activity contribute to cardiac disease progression, and the recent development of invasive techniques and electrical stimulation devices has opened new avenues for specific targeting of the sympathetic and parasympathetic branches of the ANS. The Heart Failure Association of the European Society of Cardiology recently organized an expert workshop which brought together clinicians, trialists and basic scientists to discuss the ANS as a therapeutic target in HF. The questions addressed were: (i) What are the abnormalities of ANS in HF patients? (ii) What methods are available to measure autonomic dysfunction? (iii) What therapeutic interventions are available to target the ANS in patients with HF, and what are their specific strengths and weaknesses? (iv) What have we learned from previous ANS trials? (v) How should we proceed in the future? </p>

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          Effects of increased inspired oxygen concentrations on exercise performance in chronic heart failure.

          Exercise capacity in patients with stable heart failure may be influenced by prolonged drug treatment or exercise training, but acute interventions are generally thought to have little effect. Cardiorespiratory responses to exercise were studied in 12 consecutive patients with chronic congestive heart failure who underwent serial submaximal and maximal exercise tests at inspired oxygen concentrations of 21% (room air), 30%, and 50%. Mean (SD) exercise duration during progressive testing to maximum exercise capacity was prolonged from 548 (276) s on room air to 632 (285) s on 50% oxygen (p = 0.012). During steady-state exercise at 45 W, oxygen enrichment to 50% was associated with significantly increased arterial oxygen saturation (94.6 [1.9]% to 97.5 [1.3]%), and significantly reduced minute ventilation (36.1 [8.6] l/min to 28.1 [5.9] l/min), cardiac output (7.5 [2.3] l/min to 6.5 [1.9] l/min), and subjective scores for fatigue and breathlessness (13.9 [3.1] to 11.5 [3.5]) compared with room air intermediate changes were observed with 30% inspired oxygen. Increased inspired oxygen concentrations can improve exercise performance acutely and modify the ventilatory response to exercise in patients with heart failure. Hyperoxia reduces ventilatory response and circulatory demand while maintaining oxygen delivery at a given workload. The potential benefits of increased inspired oxygen concentrations in the treatment of chronic heart failure merit further assessment.
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            Author and article information

            Journal
            European Journal of Heart Failure
            Eur J Heart Fail
            Wiley
            13889842
            November 2017
            November 2017
            September 26 2017
            : 19
            : 11
            : 1361-1378
            Affiliations
            [1 ]Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM); Maastricht University Medical Hospital; Maastricht the Netherlands
            [2 ]National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit; Royal Brompton Hospital; London UK
            [3 ]National Heart and Lung Institute; Imperial College London; London UK
            [4 ]Baker Heart and Diabetes Institute; Melbourne Vic Australia
            [5 ]Department of Cardiology and Angiology; Medical School Hannover; Hannover Germany
            [6 ]Clinic for Internal Medicine III, Cardiology; Angiology and Intensive Internal Medicine; Homburg Germany
            [7 ]First Department of Medicine, Cardiology Division; University Medical Centre Mannheim; Mannheim Germany
            [8 ]German Centre for Cardiovascular Research; Mannheim Germany
            [9 ]Department of Cardiology; Antwerp University; Antwerp Belgium
            [10 ]Department of Medicine; Monash University; Melbourne Vic Australia
            [11 ]Department of Medicine; University of Warwick; Coventry UK
            [12 ]Department of Cardiology, University Medical Centre Groningen; University of Groningen; Groningen the Netherlands
            [13 ]Laboratory of Physiopharmacology; University of Antwerp; Antwerp Belgium
            [14 ]Department of Cardiology, School of Medicine; National and Kapodistrian University of Athens, Athens University Hospital Attikon; Athens Greece
            [15 ]University Health Network and Sinai Health System Division of Cardiology, Peter Munk Cardiac Centre, Toronto General and Lunenfeld-Tanenbaum Research Institutes; University of Toronto; Toronto ON Canada
            [16 ]Clinica Medica, Department of Medicine and Surgery; University of Milan-Bicocca; Milan Italy
            [17 ]IRCCS Multimedica; Milan Italy
            [18 ]Department of Heart Diseases; Wroclaw Medical University; Wroclaw Poland
            [19 ]Centre for Heart Diseases; Military Hospital; Wroclaw Poland
            [20 ]Medtronic, Inc., Bakken Research Centre; Maastricht the Netherlands
            [21 ]Institute for Experimental Medical Research; Oslo University Hospital, University of Oslo; Oslo Norway
            [22 ]Critical Care; Orion Pharma Espoo Finland
            [23 ]University Heart Centre; University Hospital Zurich; Zurich Switzerland
            [24 ]Department of Medicine, Division of Cardiovascular Medicine; Henry Ford Hospital; Detroit MI USA
            [25 ]Department of Cellular and Integrative Physiology; University of Nebraska College of Medicine; Omaha NE USA
            [26 ]Department of Cardiology; Belgrade University Medical Centre; Belgrade Serbia
            [27 ]Department of Nuclear Medicine and Molecular Imaging, University of Groningen; University Medical Centre Groningen; Groningen the Netherlands
            [28 ]Department of Biomedical Photonic Imaging, Faculty of Science and Technology; University of Twente; Enschede the Netherlands
            [29 ]Department of Cardiovascular Science, University College London; Barts Heart Centre; London UK
            [30 ]Department of Translational Medical Sciences; Federico II University; Naples Italy
            [31 ]Department of Cardiology, Heart and Lungs Division, and Regenerative Medicine Centre; University Medical Centre Utrecht; Utrecht the Netherlands
            [32 ]INSERM, Centre for Clinical Investigation 9501, Unit 961; University Hospital Centre; Nancy France
            [33 ]Department of Cardiology; Nancy University, University of the Lorraine; Nancy France
            [34 ]Netherlands Heart Institute; Utrecht the Netherlands;
            [35 ]Department of Cardiovascular Sciences; Leuven University; Leuven Belgium
            Article
            10.1002/ejhf.921
            28949064
            3f1c8180-5ca5-4dc4-b163-28cce8a8ae2e
            © 2017

            http://doi.wiley.com/10.1002/tdm_license_1.1

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