Du X J, Cox H S, Dart A M, Esler M D
Alfred and Baker Medical Unit, Baker Medical Research Institute, and Alfred Hospital, Melbourne, Australia.
J Cardiovasc Pharmacol. 1998 Jun;31(6):937-44. doi: 10.1097/00005344-199806000-00019.
Heart failure is associated with attenuation of parasympathetic nervous function and enhanced renin-angiotensin activity. We tested whether there was a dysfunction in the efferent cholinergic neurotransmission in the heart of rats with chronic myocardial infarction (MI) and the potential role of angiotensin II (Ang II) receptors in such changes. Rats with MI and sham-operation were anesthetized, and heart rate (HR) reduction in response to vagal nerve stimulation was measured before and after losartan administration (10 mg/kg, i.v.) in the presence or absence of physostigmine to inhibit acetylcholinesterase. Infarcted rats had an average infarct size (IS) of 38% of the left ventricle (LV), depressed LV dP/dtmax, elevated LVEDP, and cardiac hypertrophy. Nerve stimulation (1-16 Hz) reduced HR in a frequency-dependent manner. The bradycardiac responses were significantly attenuated in infarcted versus control rats (p < 0.01), indicating an impaired efferent vagal tone. In contrast, the bradycardic response to exogenous acetylcholine was similar in both groups, implying an unchanged muscarinic receptor responsiveness in hearts with MI. HR response to nerve stimulation was potentiated by losartan in infarcted rats by 21 +/- 4 versus 4 +/- 2 beats/min (p < 0.01) but was unaffected in control rats. This effect of losartan was inversely related to the extent of attenuation of vagally mediated HR reduction. IS was correlated with both the extent of attenuation in vagally mediated bradycardia and the effect of losartan. In conclusion, the efferent vagal control of HR is attenuated in rats with MI and heart failure. This attenuation may be partly due to a presynaptic inhibition of acetylcholine release through the tonic activation, by Ang II, of neuronal AT1 receptors.
心力衰竭与副交感神经功能减弱及肾素 - 血管紧张素活性增强有关。我们测试了慢性心肌梗死(MI)大鼠心脏中传出胆碱能神经传递是否存在功能障碍,以及血管紧张素 II(Ang II)受体在此类变化中的潜在作用。对MI大鼠和假手术大鼠进行麻醉,在给予氯沙坦(10 mg/kg,静脉注射)前后,在有或无毒扁豆碱抑制乙酰胆碱酯酶的情况下,测量迷走神经刺激引起的心率(HR)降低情况。梗死大鼠的平均梗死面积(IS)为左心室(LV)的38%,LV dP/dtmax降低,LVEDP升高,且有心脏肥大。神经刺激(1 - 16 Hz)以频率依赖性方式降低HR。与对照大鼠相比,梗死大鼠的心动过缓反应明显减弱(p < 0.01),表明传出迷走神经张力受损。相反,两组对外源性乙酰胆碱的心动过缓反应相似,这意味着MI心脏中的毒蕈碱受体反应性未改变。氯沙坦使梗死大鼠对神经刺激的HR反应增强,从4 ± 2次/分钟增加到21 ± 4次/分钟(p < 0.01),而对照大鼠则不受影响。氯沙坦的这种作用与迷走神经介导的HR降低的减弱程度呈负相关。IS与迷走神经介导的心动过缓的减弱程度以及氯沙坦的作用均相关。总之,MI和心力衰竭大鼠中传出迷走神经对HR的控制减弱。这种减弱可能部分归因于Ang II通过神经元AT1受体的紧张性激活对乙酰胆碱释放的突触前抑制。