Mukharji J, Thames M D, Newton M, Hirsh P D, Lewis S A, Rehr R B, Cowley M J, Hess M L, Hastillo A, Lower R R
J Heart Transplant. 1987 Jan-Feb;6(1):44-8.
To assess the contribution of cardiac innervation toward understanding the mechanisms of bradycardia during contrast coronary angiography, heart rate (HR) responses in eight patients after heart transplantation were compared with 10 normal patients (control), 10 patients with coronary artery disease (CAD) and normal ventricular function, and 10 patients with congestive cardiomyopathy and normal coronary arteries. The longest P-P interval was measured beat to beat before (HR 1) and after (HR 2) coronary angiography. The coronary vessel perfusing the sinus node did not influence HR 2 responses within each group. HR 1 was significantly different from HR 2 (p less than 0.05) in the control and CAD groups but was not different in the transplant and cardiomyopathy groups. Compared with the control group, the percent decrease in HR was significantly less in transplant patients than in patients with cardiomyopathy. Thus contrast injection bradycardia is absent in denervated patients after heart transplant, and this response is markedly blunted in cardiomyopathy patients who are known to have diminished vasodepressor reflexes. These findings suggest that the bradycardia response is probably a neurally mediated phenomenon.
为评估心脏神经支配在理解冠状动脉造影期间心动过缓机制方面的作用，将8例心脏移植术后患者的心率（HR）反应与10例正常患者（对照组）、10例冠状动脉疾病（CAD）且心室功能正常的患者以及10例充血性心肌病且冠状动脉正常的患者进行了比较。在冠状动脉造影前（HR 1）和造影后（HR 2）逐搏测量最长P-P间期。在每组中，灌注窦房结的冠状动脉对HR 2反应无影响。对照组和CAD组中HR 1与HR 2有显著差异（p小于0.05），但移植组和心肌病组中无差异。与对照组相比，移植患者的HR降低百分比显著低于心肌病患者。因此，心脏移植后去神经支配的患者不存在造影剂注射后心动过缓，而在已知血管减压反射减弱的心肌病患者中这种反应明显减弱。这些发现提示心动过缓反应可能是一种神经介导的现象。
