Endothelial, Vascular and Sympathetic Alterations as Therapeutic Targets in Chronic Heart Failure

Abstract

Vascular and sympathetic abnormalities characterize chronic heart failure (CHF). Alterations include (1) a reduction in arterial distensibility, (2) endothelial dysfunction, (3) a decrease in arterial compliance and a parallel increase in arterial stiffness, and (4) sympathetic cardiovascular activation. Altogether, these alterations represent important targets in therapeutic interventions, because they display an independent negative impact on the disease prognosis, favouring disease progression and the development of cardiovascular complications with direct and indirect mechanisms. The present review will examine the effects of the different therapeutic interventions targeting the vascular/sympathetic alterations detected in CHF. Non-pharmacological, pharmacological and device-based treatments will be discussed in detail, highlighting the possible mechanisms responsible for the vascular/sympathetic effects of each intervention. Finally, the unmet goals in treatment in relation to endothelial and adrenergic targets will be also discussed.

Physiological Correlates of Hypnotizability: Hypnotic Behaviour and Prognostic Role in Medicine

“…Larger post occlusion flow-mediated dilation, in fact, is considered a predictor of less vulnerability to cardiovascular events [75], and drugs containing NO donors are administered in clinical trials [76]. Moreover, NO exerts a central inhibition of the sympathetic activity [77], which is increased in patients with heart failure [78]. In this respect, high hypnotizability may have a favorable prognostic role in case of cardiovascular events.…”