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(Circulation. 1995;92:2343-2351.)
© 1995 American Heart Association, Inc.

Articles

Distribution, Morphology, and Neurochemistry of Endocardial and Epicardial Nerve Terminal Arborizations in the Human Heart

K. Marron, BSc; J. Wharton, PhD; M.N. Sheppard, MD, MRCPath; D. Fagan, MD, FRCPath; D. Royston, MD, MRCPath; D.M. Kuhn, PhD; M.R. de Leval, MD, FRCS; B.F. Whitehead, MB, MRCP; R.H. Anderson, MD, FRCPath; J.M. Polak, MD, DSc, FRCPath

From the Department of Histochemistry, Royal Postgraduate Medical School, London, England (K.M., J.W., J.M.P.); Department of Pathology, Queen's Medical Centre, Nottingham, England (D.F.); Department of Pathology, Beaumont Hospital, Dublin, Ireland (D.R.); Laboratory of Neurochemistry, Lafayette Clinic, Detroit, Mich (D.M.K.); Cardiothoracic Surgery Unit, Great Ormond Street Hospital for Children, London, England (M.R. de L.); and Departments of Pathology (M.N.S.) and Paediatric Cardiology (K.M., R.H.A.), National Heart and Lung Institute, London, England.

Correspondence to Dr John Wharton, Department of Histochemistry, Royal Postgraduate Medical School, Du Cane Rd, London W12 ONN, UK.

Background The heart contains a variety of morphologically distinct nerve terminals known to influence cardiac function. Little is known about the distribution, morphology, and neurochemistry of these terminals in the human heart.

Methods and Results We examined the entire endocardial and epicardial surfaces of infant and adult hearts obtained postmortem and at transplantation using immunohistochemical and histochemical staining of whole-mount preparations in conjunction with confocal and fluorescence microscopy. Terminals arising from nerve fibers (diameter, 6 to 10 µm) immunoreactive for myelin basic protein were identified in the atrial endocardium, epicardium, and coronary sinus, and four types were distinguished by differences in immunostained nerve area (range, 358 to 797 µm²) and dispersion (range, 620 to 4684 µm²). These terminals displayed immunoreactivity for tyrosine hydroxylase, neuropeptide Y, and the general neural marker protein gene product 9.5. Acetylcholinesterase (AChE) activity was detected in <5% of endocardial terminals and in no epicardial terminals arising from myelinated fibers. The latter were observed in close proximity to mesothelial cells, and nerve fibers supplying these terminals were found to be associated with local ganglia. A distinct population of terminals (mean stained area, 35 µm²; 18 to 53 µm², 95% CI; and mean dispersion, 59 µm²; 38 to 80 µm², 95% CI) was demonstrated to arise from nonmyelinated fibers (mean diameter, 2.5 µm; 2.2 to 2.8 µm, 95% CI) in the endocardial plexus of the atria and left ventricle and were predominantly AChE-positive.

Conclusions Specialized nerve terminals are distributed more widely in the human heart than has been described in experimental animals. These terminals express either AChE activity or tyrosine hydroxylase and neuropeptide Y immunoreactivity, suggesting that acetylcholine, catecholamines, and neuropeptide Y may be present in sensory and autonomic nerves in the human heart.

Key Words: endocardium • nervous system • receptors • peptides • endothelium

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