Cardiac sympathetic innervation in patients with dilated cardiomyopathy--immunohistochemical study using anti-tyrosine hydroxylase antibody.

Depletion of norepinephrine in the left ventricular myocardium in cases of dilated cardiomyopathy (DCM) has been suggested. However, there have been few histological studies of the sympathetic nerves, in which myocardial norepinephrine is believed to exist. We performed an immunohistological study of the density of tyrosine hydroxylase (TH, a marker of sympathetic nerves)-positive nerve fiber in endomyocardial biopsy specimens in cases of DCM using antibody against TH. TH-positive nerves were stained brown along with the myocardium, and they were more dense in the right ventricle than in the left ventricle in both the DCM and control groups. The density of TH-positive nerves in cases of DCM was significantly less than that in the control group in the subendocardial myocardium of the right and left ventricles, but especially in the left ventricle. A correlation was observed in the DCM group between the density of TH-positive nerves and the ejection fraction in the right ventricle, but not in the left ventricle. In the failing human heart, a decrease in subendocardial sympathetic nerve density may be one of the causes of myocardial norepinephrine depletion.