(Circulation. 2000;102:2599.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Altered Adrenergic Receptor Density in Myocardial Hibernation in Humans
A Possible Mechanism of Depressed Myocardial Function
Presented in part at the Samuel A. Levine Young Clinical Investigator competition of the Scientific Sessions of the American Heart Association, Atlanta, Ga, November 7–10, 1999, and published in abstract form (Circulation. 1999;100[suppl I]:I-24).
From the Department of Medicine, Section of Cardiology (K.S., S.F.N., S.S., M.S.V., F.K., W.A.Z.), and the Department of Surgery (M.J.R., G.V.L., J.F.H.), Baylor College of Medicine; and the Department of Pathology (R.J.B., B.J.P.), University of Texas Medical School, Houston.
Background—Alterations in adrenergic receptor densities can potentially contribute to myocardial dysfunction. Their relevance to myocardial hibernation in humans is unknown.
Methods and
Results—Accordingly, 22 transmural myocardial
biopsies were obtained in 11 patients with ischemic
ventricular dysfunction during bypass surgery, guided by
transesophageal echocardiography.
Patients underwent dobutamine
echocardiography (DE) and rest scintigraphic
studies before revascularization and DE at 3 to 4
months. 
- and ß-receptor density (ARD and BRD) and extent of
fibrosis were quantified from the myocardial biopsies. Of the 22
segments, 16 had abnormal rest function and 6 were normal. Severely
hypokinetic or akinetic segments showed a 2.4-fold increase in ARD with
a concomitant 50% decrease in BRD compared with normal segments. An
increase in ARD, a decrease in BRD to a lesser extent, and thus an
increase in ARD/BRD ratio were seen in dysfunctional segments with
contractile reserve compared with normal segments and were most
pronounced in those without contractile reserve
(P<0.001). Similar findings were observed if recovery
of function or scintigraphic uptake was analyzed as a marker
for viability. No significant relation between either ARD or BRD and
percent myocardial fibrosis was noted (r=0.37 and
-0.39, respectively).
Conclusions—Thus,
graded and reciprocal changes in - and ß-adrenergic receptor
densities occur in viable, hibernating myocardium and may
account in part for the observed depression in resting myocardial
function and preserved contractile reserve in this
entity.
Key Words: receptors, adrenergic • ischemia • hibernation • dobutamine • echocardiography
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