Document Detail

Alterations of cardiac innervation in evolving myocardial infarction and transplanted hearts. An anatomo-clinical reappraisal.
MedLine Citation:
PMID:  14558295     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Debate regarding the alterations of the cardiac innervation in an evolving myocardial infarction and transplanted hearts is still raging and most studies are based on radionuclide uptake of neurotransmitters or on the evaluation of the cardiorespiratory reflex. METHODS: The present investigation, upon human autoptic specimens of 57 infarcts and 8 cardiac transplants, was carried out with traditional neuropathology and modern molecular biology techniques. The specimens were selected for the identification of neurons, nerve fibers and their sheaths. RESULTS: First of all, these techniques confirmed the gross difference in the vulnerability of infarcted myocytes if compared with the local innervation, the metabolism of which is infinitely less oxygen-dependent than that of working myocardium (approximate quantitation below). Delicate technicalities of the traditional silver impregnation for nerves usually yield a large incidence of artifacts. Thereby, only perfect results (20% of cases), corroborated by parallel nerve sheath immunostaining (70% of cases), were retained and documented herein. In the meantime, acidosis and free radicals increase, while catabolite accumulation supervenes. These three factors threaten myocardial viability. Thereby, nervelets can be seen to survive the hyperacute phase of ischemia, but may be in part damaged by the successive granulocytic-macrophage inflammation enzyme lysis of the infarcted muscle. The delayed and incomplete anatomical neural damage is confirmed by the observation of preserved nerve sheaths and neural filaments surviving in postinfarction scars, almost devoid of myocardiocytes. CONCLUSIONS: The rich sympatho-vagal cardiac network might further provide alternative bypasses for post-infarct reinnervation. The functional implications of this process remain unclear.
Lino Rossi
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  Italian heart journal : official journal of the Italian Federation of Cardiology     Volume:  4     ISSN:  1129-471X     ISO Abbreviation:  Ital Heart J     Publication Date:  2003 Jul 
Date Detail:
Created Date:  2003-10-15     Completed Date:  2004-02-05     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  100909716     Medline TA:  Ital Heart J     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  448-53     Citation Subset:  IM    
Institute of Pathology, University of Milan, Milan, Italy.
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MeSH Terms
Adrenergic Fibers / pathology,  physiology,  ultrastructure
Arrhythmias, Cardiac / pathology,  physiopathology,  surgery
Cholinergic Fibers / pathology,  physiology,  ultrastructure
Coronary Stenosis / pathology,  physiopathology,  surgery
Heart / innervation*
Heart Conduction System / pathology,  physiopathology,  ultrastructure
Heart Transplantation*
Microscopy, Electron
Myocardial Infarction / pathology*,  physiopathology,  surgery*
Myocardium / pathology,  ultrastructure
Myocytes, Cardiac / pathology,  ultrastructure
Nerve Regeneration / physiology
Neurons / pathology,  ultrastructure
Parasympathetic Nervous System / pathology,  physiopathology,  ultrastructure
Severity of Illness Index
Sympathetic Nervous System / pathology,  physiopathology,  ultrastructure
Treatment Outcome

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