McCance A J, Thompson P A, Forfar J C
Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, U.K.
Eur Heart J. 1993 Jun;14(6):751-7. doi: 10.1093/eurheartj/14.6.751.
We have evaluated overall and cardiac sympathetic activity in 47 patients undergoing coronary angiography, 27 with stable angina of at least 3 months duration, and 20 with unstable ischaemic symptoms within this period. Cardiac and overall sympathetic activity were assessed using radiotracer noradrenaline kinetic techniques to measure cardiac and total noradrenaline spillover to plasma. Overall sympathetic activity (whole body noradrenaline spillover) was similar in the two groups, whereas cardiac sympathetic activity (cardiac noradrenaline spillover) was strikingly increased in the patients with unstable ischaemic symptoms (102 +/- 23 pmol.min-1 vs 34 +/- 4 pmol.min-1, P < 0.001), as was the cardiac to whole body noradrenaline spillover ratio (0.043 +/- 0.008 vs 0.021 +/- 0.005, P < 0.01). Coronary sinus bloodflow (50 +/- 4 ml.min-1 vs 38 +/- 4 ml.min-1, P < 0.05) and coronary sinus noradrenaline concentration (2.60 +/- 0.38 nmol.l-1 vs 1.41 +/- 0.17 nmol.l-1, P < 0.01) were also increased in the patients with unstable ischemic syndromes. Left ventricular ejection fraction was similar in the two groups (63 +/- 2% vs 62 +/- 2%). Patients with unstable ischaemic symptoms within the previous three months have increased cardiac sympathetic nervous activity compared to patients with stable angina. This may in part explain why patients with unstable ischaemic syndromes are at increased risk of sudden cardiac death.
我们评估了47例接受冠状动脉造影术患者的整体和心脏交感神经活动，其中27例患有至少持续3个月的稳定型心绞痛，20例在此期间有不稳定缺血症状。使用放射性示踪剂去甲肾上腺素动力学技术评估心脏和整体交感神经活动，以测量心脏和总去甲肾上腺素向血浆中的溢出。两组患者的整体交感神经活动（全身去甲肾上腺素溢出）相似，而不稳定缺血症状患者的心脏交感神经活动（心脏去甲肾上腺素溢出）显著增加（102±23 pmol·min⁻¹ vs 34±4 pmol·min⁻¹，P<0.001），心脏与全身去甲肾上腺素溢出率也增加（0.043±0.008 vs 0.021±0.005，P<0.01）。不稳定缺血综合征患者的冠状窦血流量（50±4 ml·min⁻¹ vs 38±4 ml·min⁻¹，P<0.05）和冠状窦去甲肾上腺素浓度（2.60±0.38 nmol·L⁻¹ vs 1.41±0.17 nmol·L⁻¹，P<0.01）也增加。两组患者的左心室射血分数相似（63±2% vs 62±2%）。与稳定型心绞痛患者相比，过去三个月内有不稳定缺血症状的患者心脏交感神经活动增加。这可能部分解释了为什么不稳定缺血综合征患者心脏性猝死风险增加。
