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CLINICAL STUDY: MYOCARDIAL ISCHEMIA

Cardiac sympathetic denervationmodulates the sympathoexcitatoryresponse to acute myocardial ischemia

Shuji Joho, MD^*, Hidetsugu Asanoi, MD^*,*, Junya Takagawa, MD^*, Tomoki Kameyama, MD^*, Tadakazu Hirai, MD^*, Takashi Nozawa, MD^*, Katsumi Umeno, BS, Masashi Shimizu, MD, Hikaru Seto, MD and Hiroshi Inoue, MD, FACC^*

^* Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Toyama, Japan
First Department of Physiology, Toyama Medical and Pharmaceutical University, Toyama, Japan
Department of Radiology, Toyama Medical and Pharmaceutical University, Toyama, Japan

Manuscript received January 30, 2001; revised manuscript received October 10, 2001, accepted October 31, 2001.

^* Reprint requests and correspondence: Dr. Hidetsugu Asanoi, Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, 2630 Sugitani, Toyama 930-0194, Japan.
hidetugu{at}ms.toyama-mpu.ac.jp

OBJECTIVES: This study was designed to elucidate the influence of cardiac sympathetic denervation on the sympathoexcitatory response to acute myocardial ischemia during balloon coronary occlusion (BCO) in humans.

BACKGROUND: Alterations of cardiac sympathetic nerve function could modulate sympathetic reflexes originating from the ischemic area.

METHODS: In 23 patients with angina pectoris, we quantified the baseline cardiac sympathetic denervation of the ischemia-related area by iodine-123 metaiodobenzylguanidine (¹²³I-MIBG), and transient changes in sympathetic activity during BCO by wavelet analysis of RR interval variability.

RESULTS: Balloon coronary occlusion resulted in a transient augmentation of low-frequency (LF: 0.04 to 0.14 Hz) spectral components of RR interval variability in 4 of 12 patients with cardiac denervation and in 8 of 11 patients without denervation (p < 0.01 by the chi-square test). Consequently, the increase in LF components was significantly less during BCO in patients with cardiac denervation (34%) than in those without denervation (273%) (interaction: p < 0.05). In seven patients with severe ischemia provoked by a fall of 10% in the left ventricular ejection fraction, LF components increased by 506% during BCO, regardless of the condition of cardiac denervation. In contrast, in patients with mild ischemia provoked by a fall of <10% in the ejection fraction, changes of LF components during BCO were significantly less in patients with denervation than in those without denervation (84 vs. 344%, p < 0.05).

CONCLUSIONS: These findings suggest that if the provoked ischemia is not severe, cardiac sympathetic denervation could prevent ischemia-induced sympathoexcitation.

Abbreviations and Acronyms   123I-MIBG   +dP/dt   peak rate of rise in left ventricular pressure   –dP/dt   peak rate of fall in left ventricular pressure   BCO   balloon coronary occlusion   ECG   electrocardiogram or electrocardiographic   HF   high frequency   LAD   left anterior descending coronary artery   LCx   left circumflex coronary artery   LF   low frequency   LV   left ventricle or ventricular   LVEF   left ventricular ejection fraction   MI   myocardial infarction   123I-MIBG   iodine-123 metaiodobenzylguanidine   RCA   right coronary artery

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