Wu LZ, Huang YN, Chen Y, Ji YQ, Jin YW, Chen CX, Zhuang SY, Xu B, Xia YB, Xu TC. Chronic heart failure and heart transplantation: The relationship between autonomic function and cardiac performance. World J Transplant 2025; 15(4): 109951 [DOI: 10.5500/wjt.v15.i4.109951]
Corresponding Author of This Article
Tian-Cheng Xu, MD, PhD, CEO, Chairman, Consultant, Founder, Head, Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, No. 138 Xianlin Avenue, Qixia District, Nanjing 210023, Jiangsu Province, China. xtc@njucm.edu.cn
Research Domain of This Article
Cardiac & Cardiovascular Systems
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Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 18, 2025 (publication date) through Nov 18, 2025
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Publication Name
World Journal of Transplantation
ISSN
2220-3230
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Wu LZ, Huang YN, Chen Y, Ji YQ, Jin YW, Chen CX, Zhuang SY, Xu B, Xia YB, Xu TC. Chronic heart failure and heart transplantation: The relationship between autonomic function and cardiac performance. World J Transplant 2025; 15(4): 109951 [DOI: 10.5500/wjt.v15.i4.109951]
World J Transplant. Dec 18, 2025; 15(4): 109951 Published online Dec 18, 2025. doi: 10.5500/wjt.v15.i4.109951
Chronic heart failure and heart transplantation: The relationship between autonomic function and cardiac performance
Lin-Zhi Wu, Yi-Ning Huang, Yue Chen, Yu-Qiu Ji, Yi-Wen Jin, Cai-Xian Chen, Si-Yu Zhuang, Bin Xu, You-Bing Xia, Tian-Cheng Xu
Lin-Zhi Wu, Yi-Ning Huang, Yue Chen, Yu-Qiu Ji, Cai-Xian Chen, Si-Yu Zhuang, Bin Xu, You-Bing Xia, Tian-Cheng Xu, Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
Yi-Wen Jin, Stomatological College, Nanjing Medical University, Nanjing 211116, Jiangsu Province, China
Co-first authors: Lin-Zhi Wu and Yi-Ning Huang.
Co-corresponding authors: You-Bing Xia and Tian-Cheng Xu.
Author contributions: Wu LZ, Huang YN, Chen Y, Chen CX and Zhuang SY designed the study and wrote the manuscript; Huang YN developed the methodology; Jin YW analyzed the data and visualized the results; Xu TC, Xu B and Xia YB supervised the research, reviewed the manuscript, and administered the project; Xia YB and Xu TC played important and indispensable roles in the manuscript preparation as the co-corresponding authors.
Supported by National Key Research and Development Program of China, No. 2022YFC3500704; and Youth Talent Support Project of China Association of Acupuncture-Moxibustion, No. 2024-2026ZGZJXH-QNRC005.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tian-Cheng Xu, MD, PhD, CEO, Chairman, Consultant, Founder, Head, Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, No. 138 Xianlin Avenue, Qixia District, Nanjing 210023, Jiangsu Province, China. xtc@njucm.edu.cn
Received: May 29, 2025 Revised: June 17, 2025 Accepted: September 12, 2025 Published online: December 18, 2025 Processing time: 176 Days and 6.4 Hours
Abstract
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.
Core Tip: Autonomic nervous system (ANS) imbalance—marked by sympathetic overactivity and parasympathetic withdrawal—drives chronic heart failure (CHF) progression through oxidative stress, fibrosis, and catecholamine toxicity. Neuromodulation therapies aim to restore ANS balance and improve outcomes. After heart transplantation, autonomic dysfunction from denervation increases the risk of arrhythmias and hemodynamic instability, underscoring the prognostic value of partial reinnervation. This minireview highlights ANS modulation as a vital therapeutic target linking CHF management and post-transplant care to optimize cardiac function and long-term survival.
