SCINTIGRAPHIC ASSESSMENT OF SYMPATHETIC INNERVATION AFTER TRANSMURAL VERSUS NONTRANSMURAL MYOCARDIAL-INFARCTION
SCINTIGRAPHIC ASSESSMENT OF SYMPATHETIC INNERVATION AFTER TRANSMURAL VERSUS NONTRANSMURAL MYOCARDIAL-INFARCTION
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DOI：
10.1016/s0735-1097(10)80156-1
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发表时间：
1991-05-01
影响因子：
24
通讯作者：
MUNOZ, L
中科院分区：
文献类型：
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作者：
DAE, MW;HERRE, JM;MUNOZ, L
为探讨在犬心肌梗死后检测失神经心肌的可行性，应用彩色计算机功能图对16只犬的交感神经末梢的分布进行了比较。12只犬经冠状动脉左前降支注射乙烯基乳胶造成心肌梗死(穿壁性心肌梗死，n=6)，或结扎左冠状动脉前降支(非穿壁性心肌梗死，n=6)。四只狗作为假操作的对照组。图像模式与组织去甲肾上腺素含量和活检标本中的组织荧光显微镜结果进行比较。穿壁性脑梗塞的心脏显示缺失的MIBG和铊区域，表明有疤痕。邻近和远端显示MIBG降低，但铊摄取正常，表明存活但失神经的心肌。通过去甲肾上腺素含量的降低和神经荧光的缺失，证实了梗塞远端的去神经支配。非穿壁性心肌梗死表现为室壁变薄，铊摄取减少，梗死区MIBG明显减少或缺失，失神经支配范围扩大至梗死区以外。这些结果表明，1)MIBG显像可以检测到梗死后存活的、灌流的、失神经的心肌；2)与穿透性心肌梗死所致的远端失神经支配不同，非穿透性心肌梗死可导致交感神经的局部缺血性损害，但可能保留通过梗死区的心外膜下神经干，为心肌远端区域提供神经来源。
To evaluate the feasibility of detecting denervated myocardium in the infarcted canine heart, the distribution of sympathetic nerve endings using I-123 metaiodobenzylguanidine (MIBG) was compared with the distribution of perfusion using thallium-201, with the aid of color-coded computer functional map in 16 dogs. Twelve dogs underwent myocardial infarction by injection of vinyl latex into the left anterior descending coronary artery (transmural myocardial infarction, n = 6), or ligation of the left anterior descending coronary artery (nontransmural myocardial infarction, n = 6). Four dogs served as sham-operated controls. Image patterns were compared with tissue norepinephrine content and with histofluorescence microscopic findings in biopsy specimens.Hearts with transmural infarction showed zones of absent MIBG and thallium, indicating scar. Adjacent and distal regions showed reduced MIBG but normal thallium uptake, indicating viable but denervated myocardium. Denervation distal to infarction was confirmed by reduced norepinephrine content and absence of nerve fluorescence. Nontransmural myocardial infarction showed zones of wall thinning with decreased thallium uptake and a greater reduction or absence of MIBG localized to the region of the infarct, with minimal extension of denervation beyond the infarct. Norepinephrine content was significantly reduced in the infarct zone, and nerve fluorescence was absent.These findings suggest that 1) MIBG imaging can detect viable and perfused but denervated myocardium after infarction; and 2) as opposed to the distal denervation produced by transmural infarction, nontransmural infarction may lead to regional ischemic damage of sympathetic nerves, but may spare subepicardial nerve trunks that course through the region of infarction to provide a source of innervation to distal areas of myocardium.