Cardiac sympathetic dysantonomia in chronic orthostatic intolerance syndromes
Cardiac sympathetic dysantonomia in chronic orthostatic intolerance syndromes
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DOI：
10.1161/01.cir.0000036015.54619.b6
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发表时间：
2002-10-29
期刊：
影响因子：
37.8
通讯作者：
Eisenhofer, G
中科院分区：
文献类型：
--
作者：
Goldstein, DS;Holmes, C;Eisenhofer, G
背景-在体位性心动过速综合征（POTS）和反复的神经心源性晕厥前期（NCS）中，发生直立耐受不良而不伴有持续的交感神经循环衰竭。这些情况是否涉及异常的心脏交感神经支配或功能尚不清楚。方法和结果-POTS或NCS患者进行了心脏释放，再摄取和交感神经递质去甲肾上腺素合成的神经化学指标的测量，根据去甲肾上腺素进入心脏静脉引流（心脏去甲肾上腺素溢出），循环H-3-去甲肾上腺素的心脏提取，和心脏产生的二羟苯丙氨酸，并使用6-[F-18]氟多巴正电子发射断层扫描测量左心室心肌神经支配密度。POTS组的平均心脏去甲肾上腺素溢出（171 +/- 30 pmol/min，N=16）高于一大组健康志愿者（102 +/- 9 pmol/min，N=52）和年龄匹配的健康女性亚组（106 +/-18 pmol/min，N = 11），NCS组（62 +/- 9 pmol/min，N=20）低于一大组健康志愿者（102 +/- 9 pmol/min，N=52）和年龄匹配的健康女性亚组（106 +/- 18 pmol/min，N=11）。两个患者组有正常的心脏提取H-3-去甲肾上腺素，正常的心脏生产的二羟苯丙氨酸，和正常的心肌6-[F-18]氟多巴胺衍生的radioactivity. Conclusions-POTS和NCS不同的紧张性心脏交感神经功能，增加心脏去甲肾上腺素释放在前者和后者减少释放。两组的细胞膜去甲肾上腺素转运体、去甲肾上腺素合成和心肌交感神经支配密度的功能指数均正常。因为POTS和NCS都包括心脏交感神经功能的特定异常，所以两者都可以被认为是自主神经功能障碍的形式。
Background-In postural tachycardia syndrome (POTS) and repeated neurocardiogenic presyncope (NCS), orthostatic intolerance occurs without persistent sympathetic neurocirculatory failure. Whether these conditions involve abnormal cardiac sympathetic innervation or function has been unclear.Methods and Results-Patients with POTS or NCS underwent measurements of neurochemical indices of cardiac release, reuptake, and synthesis of the sympathetic neurotransmitter norepinephrine based on entry of norepinephrine into the cardiac venous drainage (cardiac norepinephrine spillover), cardiac extraction of circulating H-3-norepinephrine, and cardiac production of dihydroxyphenylalanine and measurement of left ventricular myocardial innervation density using 6-[F-18]fluorodopamine positron emission tomographic scanning. Mean cardiac norepinephrine spillover in POTS (171 +/- 30 pmol/min, N=16) was higher and in NCS (62 +/- 9 pmol/min, N=20) was lower than in a large group of healthy volunteers (102 +/- 9 pmol/min, N=52) and in a subgroup of age-matched healthy women (106 +/- 18 pmol/min, N=11). Both patient groups had normal cardiac extraction of H-3-norepinephrine, normal cardiac production of dihydroxyphenylalanine, and normal myocardial 6-[F-18]fluorodopamine-derived radioactivity.Conclusions-POTS and NCS differ in tonic cardiac sympathetic function, with increased cardiac norepinephrine release in the former and decreased release in the latter. Both groups had normal values for indices of function of the cell membrane norepinephrine transporter, norepinephrine synthesis, and density of myocardial sympathetic innervation. Because POTS and NCS both include specific abnormalities of cardiac sympathetic function, both can be considered forms of dysautonomia.