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

Eur Heart J. 2015 Aug 7;36(30):1974-82b. doi: 10.1093/eurheartj/ehv087. Epub 2015 May 13.


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.

Keywords: Baroreceptor reflex; Chemoreceptor reflex; Exercise; Heart failure; Human; Parasympathetic nervous system; Sleep apnoea; Sympathetic nervous system.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Afferent Pathways / physiology
  • Autonomic Nervous System Diseases / complications*
  • Autonomic Nervous System Diseases / physiopathology
  • Autonomic Nervous System Diseases / therapy
  • Baroreflex / physiology
  • Biomarkers / metabolism
  • Central Nervous System Diseases / complications
  • Central Nervous System Diseases / physiopathology
  • Chemoreceptor Cells / physiology
  • Heart Failure / etiology*
  • Heart Failure / physiopathology
  • Heart Failure / therapy
  • Heart Rate / physiology
  • Humans
  • Kidney / innervation
  • Mechanoreceptors / physiology
  • Muscle, Skeletal / physiology
  • Prognosis
  • Sleep Wake Disorders / etiology
  • Sleep Wake Disorders / physiopathology
  • Stroke Volume / physiology


  • Biomarkers