Chronic heart failure and heart transplantation: The relationship between autonomic function and cardiac performance.

Chronic heart failure (CHF) is a complex clinical syndrome characterized by impaired cardiac function and neurohormonal dysregulation. While CHF has traditionally been regarded as a hemodynamic disorder, growing evidence highlights the pivotal role of autonomic nervous system (ANS) dysfunction in its progression and prognosis. The ANS, comprising sympathetic and parasympathetic branches, exerts significant control over cardiac function, including heart rate, contractility, and vascular tone. In CHF, sympathetic overactivation coupled with parasympathetic withdrawal contributes to adverse cardiac remodeling, arrhythmogenesis, and further deterioration of cardiac performance. This minireview summarizes current knowledge on the role of autonomic dysfunction in CHF and heart transplantation. It focuses on how sympathetic nervous system imbalance contributes to CHF progression and explores the impact of autonomic dysregulation on post-transplant outcomes. By synthesizing existing evidence, the review highlights ANS modulation as a key therapeutic target for improving cardiac function and patient prognosis in both clinical settings.