Evidence shows that there is a genuine physical and reciprocal connection between the mind and the body defined by physiological pathways and organic structural remodeling of the elements of these interactions. Further, interventions and practices such as biofeedback, relaxation therapies, and meditation clearly alter at least acutely if not chronically the effector systems governing mind-body and mind-heart interactions. Less clear is the role these interventions may play in the immediate or future management of patients with ventricular failure. There is at this time a paucity of studies that directly address these questions in patients with congestive heart failure. Is it possible that mind-heart intervention techniques can reverse the remodeling of many of these pathways, including the known aberrations of autonomic balance that evolve early in the course of ventricular failure and that may contribute to the progression of the disease process?25 Can mind-body and mind-heart interactions address the significant depression and anxiety that are prevalent in patients with congestive heart failure and reverse the neuroimmune activation operative in both conditions?9,13,27,28,55,69,80 The evidence-based medicine to address these questions is lacking. As can be seen from the literature discussed in this review, the clinical studies of mind-heart interventions are often uncontrolled and underpowered owing to small sample sizes. This has been recognized as a major limitation faced by a large number of studies investigating mind-body interventions. 103,134 In an era of translational investigation, this appears to be a field ideally suited to the evolving scientific. Table Presented. methods that connect fundamental scientific discovery to clinical practice. It is possible that these interventions will constitute important therapies complementary to current standard care. As an example, a population-based study examining the impact of spirituality on autonomic function and cardiovascular disease found that an increase in the aggregate score of spirituality measures highly correlated with autonomic control.3 This is relevant to patients with congestive heart failure, who, with progressive severity of disease, lose diurnal variation of parasympathetic/sympathetic balance, which in effect represents a lack of what has been defined as autonomic control. 135-138 Therefore, is it possible that mind-body interventions can restore normal autonomic control in patients with congestive heart failure? Could these interventions increase responsiveness to pharmacological treatment? The role that mind-heart interventions will play in the future treatment of patients with congestive heart failure is yet to be defined. Although there is the clear indication that the field of behavioral cardiology is one that is likely to continue its evolution and play a significant role in the advancement of patient care, it is also clear that this must be preceded by further studies confirming benefit and defining this field of practice.134 Further, although complementary and alternative therapies are embraced by many patients, they require commitment of time and to lifestyle change.139 Nevertheless, the reality of the mind-heart connection cannot be ignored, and cardiovascular specialists must continue to engage in the understanding, translational research, and application of this field. Translational science must now meet the challenge to build on the intriguing studies that have established the mechanistic basis for mind-heart interactions. There are a wide variety of investigations that must follow. The authors suggest a few: • Investigate the capacity of mind-heart interactions to increase susceptibility to pharmacological therapy and to cardiac resynchronization therapy. • Test whether the response to drug administration coordinated with mind-heart interventions is augmented compared with standard dosing regimens. • Test the capacity of mind-heart interventions to alleviate comorbid conditions such as sleep disorders that commonly accompany ventricular failure are themselves influenced by states of stress and anxiety.140 • Evaluate the capacity of mind-heart interventions to improve ventricular function through interruption of the cascade of autonomic and proinflammatory pathways activated by depression and stress.141,142 • Investigate the response to mind-body interventions in the context of different genetic backgrounds similar to the pharmacogenetic impact on drug response. Conversely, evaluate the impact of mind-heart interventions on gene function based on preliminary studies showing the plausibility of "mind/gene" interactions.143,144 These constitute just a few of the exciting possibilities for translational research in mind-heart medicine and adapting this field to the overall clinical and investigative approach to patients with congestive heart failure. It is hoped that the field of translational cardiovascular medicine will explore research questions such as these and others to allow mind-heart interventions to take a place in the growing armamentarium of heart failure therapies. © 2010 American Heart Association, Inc.
