Therapeutic targeting of splanchnic nerves

The venous capacitance of the splanchnic vascular bed plays a pivotal role across the cardiovascular disease spectrum, and at the opposing extremes of that spectrum are patients with heart failure and dysautonomia. One possible mechanism of heart failure exacerbation, driven by neurohormonal imbalance, is the reduced ability of the vascular bed to store blood. The increased sympathetic tone generated by greater splanchnic nerves results in volume redistribution from abdominal compartment to thoracic compartment. This results in increased intracardiac pressures and precipitates heart failure signs/symptoms. Therefore, blocking the greater splanchnic nerves is a potential target and under investigation for the treatment of heart failure. We discuss the role of the splanchnic vascular compartment in the regulation of intravascular blood volume, and cardiac preload, as well as the impact of the dysregulation of the same. Finally, we review surgical and pharmacological means that have been applied to modulate the splanchnic vascular compartment for the treatment of cardiovascular disease, specifically heart failure.

Duke Scholars

Author Marat Fudim Medicine, Cardiology