Extracardiac neural remodeling in humans with cardiomyopathy.
Extracardiac neural remodeling in humans with cardiomyopathy.
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DOI：
10.1161/circep.112.972836
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发表时间：
2012-10
期刊：
影响因子：
--
通讯作者：
Shivkumar K
中科院分区：
文献类型：
--
作者：
Ajijola OA;Wisco JJ;Lambert HW;Mahajan A;Stark E;Fishbein MC;Shivkumar K
心肌梗死后心肌内神经出芽与室性心律失常（VA）有关。人类星状神经节重构是否与心脏病理学有关尚不清楚。本研究的目的是确定心脏病理学是否与人类星状神经节的重塑有关。左星状神经节（LSG）从接受交感神经去神经治疗顽固性室性心律失常的患者和尸体中收集，沿着完整的心脏。对患者和尸体受试者的临床数据进行了审查。我们将来自正常、瘢痕和无瘢痕的非缺血性心肌病心脏的神经节分别分类为NL（n=3）、SCAR（n=24）和NICM（n=7）。在LSG内，测定神经元的大小、密度、纤维化、突触密度和神经发芽。神经密度和发芽也定量尸体心脏。NL、SCAR和NICM组的平均神经元尺寸分别为320±4μm2、372±10μm2和435±10μm2（p=0.002）。两组间神经元密度和纤维化无显著差异。SCAR和NICM神经节的突触密度分别为57.8±11.2um2/mm 2（p=0.039）和44.5±7.9um2/mm 2（p=0.084），而NL为17.8± 7 um 2/mm 2（总体p=0.162）。各组间LSG神经出芽和心肌神经密度无显著差异。LSG内神经元肥大与人类慢性心肌病相关神经节和心肌的神经发芽和神经密度无显着差异。这些变化可能与心脏交感神经信号和VA增加有关。需要进一步的研究来确定人类心脏外神经元重塑的电生理后果。
Intra-myocardial nerve sprouting after myocardial infarction is associated with ventricular arrhythmias (VAs). Whether human stellate ganglia remodel in association with cardiac pathology is unknown. The purpose of this study was to determine whether cardiac pathology is associated with remodeling of the stellate ganglia in humans. Left stellate ganglia (LSG) were collected from patients undergoing sympathetic denervation for intractable ventricular arrhythmias, and from cadavers, along with intact hearts. Clinical data on patients and cadaveric subjects were reviewed. We classified ganglia from normal; scarred; and non-ischemic cardiomyopathic hearts without scar as NL (n=3); SCAR (n=24); and NICM (n=7), respectively. Within LSG, neuronal size, density, fibrosis, synaptic density and nerve sprouting were determined. Nerve density and sprouting were also quantified in cadaveric hearts. Mean neuronal size in NL, SCAR, and NICM groups were; 320±4μm2, 372±10μm2,and 435±10μm2 (p=0.002). No significant differences in neuronal density and fibrosis were present between the groups. Synaptic density in SCAR and NICMganglia were 57.8±11.2um2/ mm2 (p=0.039) and 44.5±7.9um2/ mm2 (p=0.084) respectively, compared to the NL, 17.8±7um2/ mm2 (overall p=0.162). There were no significant differences in LSG nerve sprouting or myocardial nerve density between the groups. Neuronal hypertrophy withinLSGis associated with chronic cardiomyopathy in humans. Ganglionic and myocardial nerve sprouting and nerve density were not significantly different. These changes may be related to increased cardiac sympathetic signaling and VAs. Further studies are needed to determine the electrophysiologic consequences of extra-cardiac neuronal remodeling in humans.