心脏交感神经支配对冠状动脉血流的影响。

Effects of cardiac sympathetic innervation on coronary blood flow.

作者信息

Di Carli M F, Tobes M C, Mangner T, Levine A B, Muzik O, Chakroborty P, Levine T B

机构信息

Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA.

出版信息

N Engl J Med. 1997 Apr 24;336(17):1208-15. doi: 10.1056/NEJM199704243361703.

DOI:10.1056/NEJM199704243361703

PMID:9110908

Abstract

BACKGROUND

The role of cardiac sympathetic nerves in regulating coronary blood flow is controversial. We sought to determine the degree to which cardiac efferent sympathetic signals modulate coronary blood flow. The heterogeneous sympathetic reinnervation in transplanted hearts provides a model for studying the vasomotor responses to adrenergic stimulation in reinnervated and denervated coronary territories of the same heart.

METHODS

We studied 14 cardiac-transplant recipients who had normal coronary arteries and no evidence of rejection and 8 normal subjects. We used positron-emission tomography with [(11)C]hydroxyephedrine, an analogue of norepinephrine, to delineate sympathetic innervation. Using [(13)N]ammonia, we measured myocardial blood flow at rest, during adenosine-induced hyperemia, and in response to sympathetic stimulation induced by cold pressor testing.

RESULTS

In the transplant recipients, the uptake of [(11)C]hydroxyephedrine was greater in the territory served by the left anterior descending artery (0.15+/-0.01) than in those served by the right coronary artery (0.07+/-0.01, P<0.001) or the circumflex artery (0.09+/-0.01, P<0.001). The basal flow was similar in all three regions, as was the percent increase in flow during hyperemia. However, the increase in flow in response to cold pressor testing was higher in the territory of the left anterior descending artery (46+/-10 percent) than in those of the right coronary artery (16+/-5 percent, P=0.01) or the circumflex artery (23+/-6 percent, P=0.06), although the changes in hemodynamics and levels of circulating catecholamines were similar. No such regional differences were observed in the normal subjects.

CONCLUSIONS

Increases in coronary blood flow in response to sympathetic stimulation correlated with the regional norepinephrine content in the cardiac sympathetic-nerve terminals. These findings suggest that cardiac adrenergic signals play an important part in regulating myocardial blood flow.

摘要

背景

心脏交感神经在调节冠状动脉血流中的作用存在争议。我们试图确定心脏传出交感神经信号调节冠状动脉血流的程度。移植心脏中交感神经再支配的异质性为研究同一心脏中再支配和去神经支配的冠状动脉区域对肾上腺素能刺激的血管运动反应提供了一个模型。

方法

我们研究了14名冠状动脉正常且无排斥反应证据的心脏移植受者和8名正常受试者。我们使用[(11)C]羟基麻黄碱（去甲肾上腺素的类似物）进行正电子发射断层扫描来描绘交感神经支配情况。使用[(13)N]氨，我们在静息状态、腺苷诱导的充血期间以及冷加压试验诱导的交感神经刺激反应中测量心肌血流。

结果

在移植受者中，左前降支供血区域[(11)C]羟基麻黄碱的摄取量（0.15±0.01）高于右冠状动脉供血区域（0.07±0.01，P<0.001）或回旋支供血区域（0.09±0.01，P<0.001）。所有三个区域的基础血流相似，充血期间血流增加的百分比也相似。然而，冷加压试验引起的左前降支供血区域血流增加（46±10%）高于右冠状动脉供血区域（16±5%，P=0.01）或回旋支供血区域（23±6%，P=0.06），尽管血流动力学变化和循环儿茶酚胺水平相似。在正常受试者中未观察到这种区域差异。