Alterations of myocardial presynaptic sympathetic innervation in patients with multi-vessel coronary artery disease but without history of myocardial infarction
Alterations of myocardial presynaptic sympathetic innervation in patients with multi-vessel coronary artery disease but without history of myocardial infarction
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DOI：
10.1097/01.mnm.0000061044.24401.6d
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发表时间：
2003-03-01
影响因子：
1.5
通讯作者：
Bengel, FM
中科院分区：
文献类型：
--
作者：
Bülow, HP;Stahl, F;Bengel, FM
在心肌梗死患者中，左心室去交感神经支配超过了瘢痕组织的大小。然而，对冠状动脉疾病（CAD）但无心肌梗死患者的局部神经支配知之甚少。使用正电子发射断层扫描（PET）与N-13-氨和C-11-羟麻黄碱（HED），静息灌注和突触前交感神经支配进行了研究8例（7名男性，1名女性; 58 +/- 9岁）多血管CAD和无心肌梗死病史。使用PET数据的极坐标图分析，将结果与正常数据库进行区域比较。平均HED保留为8.0% +/- 2.0%.min（-1）。24个血管区域中有23个心肌静息灌注正常。尽管正常的静息灌注，显着减少HED保留，表明神经支配障碍，被发现在14的23（61%）的血管领土（6的8名患者）。在神经支配障碍的区域中，11例（79%）血管造影显示严重狭窄（大于或等于90%的自体血管/冠状动脉旁路移植物），8例（57%）显示缺血（心肌灌注造影/负荷心电图），12例（86%）已进行血运重建。在神经支配正常的9个节段中，2个（22%）显示严重狭窄，2个（22%）显示缺血，7个（78%）已进行血运重建。可以得出结论，在晚期CAD和左心室功能正常的患者中，神经支配障碍可以在没有心肌梗死的情况下发生。这与交感神经元比肌细胞更易受缺血性损伤的假设一致。((C)2003 Lippincott威廉姆斯威尔金斯）。
In patients with myocardial infarction, left ventricular sympathetic denervation exceeds the size of the scar tissue. However, little is known about the regional innervation in patients with coronary artery disease (CAD) but no myocardial infarction. Using positron emission tomography (PET) with N-13-ammonia and C-11-hydroxyephedrine (HED), resting perfusion and presynaptic sympathetic innervation were studied in eight patients (seven males, one female; 58 +/- 9 years) with multi-vessel CAD and no history of myocardial infarction. Using polar map analysis of the PET data, the results were regionally compared with normal databases. The mean HED retention was 8.0% +/- 2.0%.min(-1). Myocardial resting perfusion was normal in 23 of 24 vascular territories. Despite normal resting perfusion, significantly reduced HED retention, indicating dysinnervation, was found in 14 of 23 (61%) vascular territories (six of eight patients). Of the dysinnervated territories, 11 (79%) showed angiographically severe stenosis (greater than or equal to90% of native vessel/coronary artery bypass graft), eight (57%) showed ischaemia (myocardial perfusion scintigraphy/stress-electrocardiogram) and 12 (86%) had been revascularized. Of the nine segments with normal innervation, two (22%) revealed severe stenosis, two (22%) showed ischaemia and seven (78%) had been revascularized. It can be concluded that, in patients with advanced CAD and normal left ventricular function, dysinnervation can occur in the absence of myocardial infarction. This is consistent with the hypothesis that sympathetic neurones are more susceptible than myocytes to ischaemic damage. ((C) 2003 Lippincott Williams Wilkins).