Innervation of the coronary arteries and its role in controlling microvascular resistance

The coronary circulation plays a crucial role in balancing myocardial perfusion and oxygen demand to prevent myocardial ischemia. Extravascular compressive forces, coronary perfusion pressure, and microvascular resistance are involved to regulate coronary blood flow throughout the cardiac cycle. Autoregulation of the coronary blood flow through dynamic adjustment of microvascular resistance is maintained by complex interactions among mechanical, endothelial, metabolic, neural, and hormonal mechanisms. This review focuses on the neural mechanism. Anatomy and physiology of the coronary arterial innervation have been extensively investigated using animal models. However, findings in the animal heart have limited applicability to the human heart as cardiac innervation is generally highly variable among species. So far, limited data are available on the human coronary artery innervation, rendering multiple questions unresolved. Recently, the clinical entity of ischemia with non-obstructive coronary arteries has been proposed, characterized by microvascular dysfunction involving abnormal vasoconstriction and impaired vasodilation. Thus, measurement of microvascular resistance has become a standard diagnostic for patients without significant stenosis in the epicardial coronary arteries. Neural mechanism is likely to play a pivotal role, supported by the efficacy of cardiac sympathetic denervation to control symptoms in patients with angina. Therefore, understanding the coronary artery innervation and control of microvascular resistance of the human heart is increasingly important for cardiologists for diagnosis and to select appropriate therapeutic options. Advancement in this field can lead to innovations in diagnostic and therapeutic approaches for coronary artery diseases.

The relevance of the superior cervical ganglion for cardiac autonomic innervation in health and disease: a systematic review

PURPOSE

The heart receives cervical and thoracic sympathetic contributions. Although the stellate ganglion is considered the main contributor to cardiac sympathetic innervation, the superior cervical ganglia (SCG) is used in many experimental studies. The clinical relevance of the SCG to cardiac innervation is controversial. We investigated current morphological and functional evidence as well as controversies on the contribution of the SCG to cardiac innervation.

METHODS

A systematic literature review was conducted in PubMed, Embase, Web of Science, and COCHRANE Library. Included studies received a full/text review and quality appraisal.

RESULTS

Seventy-six eligible studies performed between 1976 and 2023 were identified. In all species studied, morphological evidence of direct or indirect SCG contribution to cardiac innervation was found, but its contribution was limited. Morphologically, SCG sidedness may be relevant. There is indirect functional evidence that the SCG contributes to cardiac innervation as shown by its involvement in sympathetic overdrive reactions in cardiac disease states. A direct functional contribution was not found. Functional data on SCG sidedness was largely unavailable. Information about sex differences and pre- and postnatal differences was lacking.

CONCLUSION

Current literature mainly supports an indirect involvement of the SCG in cardiac innervation, via other structures and plexuses or via sympathetic overdrive in response to cardiac diseases. Morphological evidence of a direct involvement was found, but its contribution seems limited. The relevance of SCG sidedness, sex, and developmental stage in health and disease remains unclear and warrants further exploration.

Comparative physiological anthropogeny: exploring molecular underpinnings of distinctly human phenotypes

Anthropogeny is a classic term encompassing transdisciplinary investigations of the origins of the human species. Comparative anthropogeny is a systematic comparison of humans and other living nonhuman hominids (so-called "great apes"), aiming to identify distinctly human features in health and disease, with the overall goal of explaining human origins. We begin with a historical perspective, briefly describing how the field progressed from the earliest evolutionary insights to the current emphasis on in-depth molecular and genomic investigations of "human-specific" biology and an increased appreciation for cultural impacts on human biology. While many such genetic differences between humans and other hominids have been revealed over the last two decades, this information remains insufficient to explain the most distinctive phenotypic traits distinguishing humans from other living hominids. Here we undertake a complementary approach of "comparative physiological anthropogeny," along the lines of the preclinical medical curriculum, i.e., beginning with anatomy and considering each physiological system and in each case considering genetic and molecular components that are relevant. What is ultimately needed is a systematic comparative approach at all levels from molecular to physiological to sociocultural, building networks of related information, drawing inferences, and generating testable hypotheses. The concluding section will touch on distinctive considerations in the study of human evolution, including the importance of gene-culture interactions.

Innervation of the heart: Anatomical study with application to better understanding pathologies of the cardiac autonomics

Current advances in management of the cardiac neuroaxis in different cardiovascular diseases require a deeper knowledge of cardiac neuroanatomy. The aim of the study was to increase knowledge of the human fetal extrinsic cardiac nervous system. We achieved this by systematizing the origin and formation of the cardiac nerves, branches, and ganglia and their sympathetic/parasympathetic connections. Thirty human fetuses (60 sides) were subjected to detailed sub-macroscopic dissection of the cervical and thoracic regions. Cardiac accessory ganglia lying on a cardiac nerve or in conjunction with two or more (up to four) nerves before entering the mediastinal cardiac plexus were observed in 13 sides. Except for the superior cardiac nerve, the sympathetic cardiac nerves were individually variable and inconstant. In contrast, the cardiac branches of the vagus nerve appeared grossly more constant and invariable, although the individual cardiac branches varied in number and position of origin. Each cervical cardiac nerve or cardiac branch of the vagus nerve could be singular or multiple (up to six) and originated from the sympathetic trunk or the vagus nerve by one, two, or three roots. Sympathetic nerves arose from the cervical-thoracic ganglia or the interganglionic segment of the sympathetic trunk. Connections were found outside the cardiac plexus. Some cardiac nerves were connected to non-cardiac nerves, while others were connected to each other. Common sympathetic/parasympathetic cardiac nerve trunks were more frequent on right (70%) versus left sides (20%). The origin, frequency, and connections of the cardiac nerves and branches are highly variable in the fetus. Detailed knowledge of the normal neuroanatomy of the heart could be useful during cardiac neuromodulation procedures and in better understanding nervous pathologies of the heart.

Morphotopographic characteristics of the extrinsic innervation of the heart in guinea pigs (Cavia porcellus)

BACKGROUND

No reports have been made on the entire extrinsic innervation of the heart in small laboratory animals. Therefore, this study examined the detailed morphotopographic features of the extrinsic cardiac autonomic nervous system (ECANS) with its adjacent structures (1) to record the general morpho-topography and variations of the ECANS in guinea pigs, (2) to compare it with previous reports on common laboratory rodents (rats, mice, and Syrian hamsters), rabbits, domesticated animals (cats, dogs, sheep, goats, oxen, pigs, and horses), primates, and humans, and (3) to infer the macroscopic evolutionary changes they presented.

METHODS

The sympathetic ganglia, vagi, and emitting cardiac nerves/branches in the cervical and thoracic regions were dissected in 24 sides of 12 formalin-fixed, arterially injected adult male and female guinea pigs under a stereomicroscope.

RESULTS

The ECANS in guinea pigs presented following general morphologic characteristics: 1) constant existence of the cranial cervical ganglion (CG) and placing caudal to the cranial base over the ventrolateral aspect of the longus capitis muscle, dorsomedial to the common carotid artery and communicating to the first two cervical spinal nerves, 2) the lack of the vago-sympathetic trunk, 3) the existence of the middle cervical ganglion (MG) and lying on the lateral aspect of the longus colli muscle (LC) at the level of the seventh cervical vertebra, 4) constant existence of the cervicothoracic ganglion (CT) composing generally from the caudal cervical ganglion and 1-3 thoracic ganglia and placing ventral to the first and second intercostal spaces over the lateral aspect of the LC and communicating to the eight cervical and first three thoracic spinal nerves in addition to the vertebral nerve, 5) constant existence of the limbs of the ansa subclavia (AS) joining the CT to MG, 6) the existence of individual thoracic ganglia from the 4th to the 12th and joining by single interganglionic branches (IGBs), and communicating to corresponding thoracic nerve, 7) the intimate relation between the caudal part of the thoracic sympathetic chain and the quadratus lumborum muscle, 8) the main cardiac nerves (CNs) emerging from the CT, 9) the lack of CNs springing generally from the CG, ST, AS, MG, or individual thoracic ganglia or their IGBs, and 10) the existence of the cardiac branches (CBs) emerging from the vagi and recurrent laryngeal nerves. The ECANS morphology in guinea pigs also shows sex and laterality differences.

CONCLUSIONS

The general anatomical arrangement of the sympathetic components of the ECANS in guinea pigs extremely displaced features common to rats and Syrian hamsters regardless of the existence of MG and the close relation between the thoracic sympathetic chain and the quadratus lumborum muscle. However, the position and organization of the CT, along with its rami communicantes to spinal nerves in guinea pigs quite resembled those seen in rats. The general macroscopic arrangement of the sympathetic components of the ECANS in guinea pigs resembled that seen in rabbits regardless of the organization and location of the CT. The general morphology of the sympathetic components of the ECANS demonstrated markedly morphological variations and similarities among common laboratory rodents, rabbits, domesticated animals (DNs), primates, and humans. The main variations consisted of the position of the CG and its rami communicantes with the spinal nerves, the relation between the vagi and sympathetic trunks in the neck, the existence of the MG, the location and arrangement of the CT, the origins and incidences of the cardiac nerves, and the main sympathetic contributors. The general macroscopic architecture of the parasympathetic components of the ECANS in guinea pigs quite resembled that seen in domesticated animals, primates, and humans. Evolutionary comparative morphologic characteristics of the ECANS are discussed in detail and evolutionary differences and similarities of the ECANS have been found from common laboratory rodents, rabbits, domesticated animals, and primates to humans.

Detailed gross anatomy and topography of the sympathetic cardiac nerves and related ganglia in Syrian hamsters (Mesocricetus auratus)

BACKGROUND

The detailed morphology and topography of the sympathetic cardiac nerves (SCNs) and ganglia with their surrounding structures in Syrian hamsters were examined to document the general topography and morphology and variations and to discuss the comparative anatomy between the SCNs and ganglia in Syrian hamsters and other rodents, as well as their comparative morphology and macroscopic evolutionary changes among rodents, rabbits, domestic animals (cats, dogs, sheep, goats, oxen, pigs and horses), primates, and humans.

METHODS

The composition of the cervical and thoracic parts of the sympathetic trunks and ganglia was bilaterally microdissected in twenty-eight sides of 14 adult male and female Syrian hamsters under a stereomicroscope.

RESULTS

The general morphology of the SCNs and related ganglia in Syrian hamsters was obtained and noted as follows: (1) the absence of the vago-sympathetic trunk, (2) the absence of the middle cervical ganglion (MG), (3) constant presence of the cervicothoracic ganglion (CT) comprising generally from the caudal cervical ganglion and 1-2 thoracic ganglia and locating over the lateral surface of the longus colli muscle ventral to the heads of the first two ribs and communicating to the eight cervical and first two thoracic spinal nerves (C8-T2) in addition to the vertebral nerve, (4) extensive coverage of the lateral surface of the CT by branches of the subclavian artery, (5) the cranial and caudal limbs of the ansa subclavia (AS) joining the CT to the caudal end of the cervical sympathetic trunk, (6) the presence of an independent thoracic ganglion from the 2nd or 3rd to the 13th and connecting by single interganglionic branches, and communicating to each thoracic spinal nerve, (7) close relationship between the caudal portion of the thoracic sympathetic trunk and the psoas minor muscle, (8) the primary cardiac nerves (CNs) arising from the CT, and (9) the absence of CNs originating generally from the cervical sympathetic trunk, AS, MG, or independent thoracic ganglia or their interganglionic branches. Individual variations of the SCNs and ganglia in Syrian hamsters were noted, including the absence of the ansa subclavia on 5/28 sides (17.86%), the presence of the intermediate ganglia (IG) placed on the C7 on 3/28 sides (10.71%) or the C8 on 3/28 sides (10.71%), and no CNs arising from the IG as well as the presence of the double thoracic sympathetic trunk on 5/28 sides (17.86%). The anatomical characteristics of the SCNs and related ganglia were also exhibited sex and laterality differences.

CONCLUSIONS

From a comparative anatomy viewpoint, the general morphology of the SCNs and related ganglia in Syrian hamsters was very similar to that in rats but was considerably different from that in guinea pigs, especially concerning the MG, cranial position and composition of the CT. The general morphology of the SCNs and related ganglia in Syrian hamsters and other laboratory rodents resembled that of rabbits but was essentially different from that in rabbits with respect to the cranial position and composition of the CT. The general morphology of the SCNs and ganglia exhibited significant morphological differences and similarities among laboratory rodents, rabbits, domestic animals, primates, and humans. The main differences include the relationship between the cervical parts of the vagus nerve and sympathetic trunk, the presence of the MG, the position and composition of the CT, the origins and frequencies of the cardiac nerves, and the primary sympathetic contributor. From macroscopic evolutionary change, the expansion of the range of the SCNs origin has occurred from laboratory rodents, rabbits, domestic animals, and primates to humans.

Muscle-tendon arrangement and innervation pattern of the m. flexor digitorum superficialis in the common marmoset (Callithrix jacchus), squirrel monkey (Saimiri sciureus) and spider monkey (Ateles sp.)

The muscle-tendon arrangement of the m. flexor digitorum superficialis (FDS) varies among different primate groups. Recent developmental investigations revealed that the primordium of FDS emerges in the hand region first and relocates to the forearm later. The relationship between the diverse muscle-tendon arrangement and the characteristic developmental process of FDS is important for understanding the evolutionary changes of the FDS. Moreover, the innervation pattern cannot go unremarked when discussing the muscle homology and evolution. We examined the muscle-tendon arrangement and intramuscular nerve distribution of the FDS in three genera of Platyrrhini: three common marmosets (Callithrix jacchus), two squirrel monkeys (Saimiri sciureus) and two spider monkeys (Ateles sp.). We observed that the FDS consisted of multiple muscle bellies. The origin of the muscle bellies to digits II and V varied, whereas muscle bellies to digits III and IV consistently originated from the medial epicondyle. The muscle-tendon arrangement of the FDS differed among the three genera owing to the different origins of muscle bellies to digits II and V. In all the examined specimens, the muscle bellies to digits II and/or III were innervated by the direct nerve branches from the median nerve. However, the muscle bellies to digits IV and V never received direct nerve branches from the median nerve. Nerve branches within the belly to digit III extended into the belly to digit IV, and one nerve branch within the belly to digit IV extended into the belly to digit V. These consistent nerve distribution patterns suggest that different patterns of FDS muscle-tendon arrangement have changed from that of a common ancestral condition. It is plausible that the diverse origins of muscle bellies in the FDS are attributable to the difference in the destination for the relocation of the muscle bellies during developmental processes.

Noninvasive cardiac psychophysiology as a tool for translational science with marmosets

The importance of marmosets for comparative and translational science has grown in recent years because of their relatively rapid development, birth cohorts of twins, family social structure, and genetic tractability. Despite this, they remain understudied in investigations of affective processes. In this methodological note, we establish the validity of using noninvasive commercially available equipment to record cardiac physiology and compute indices of autonomic nervous system activity-a major component of affective processes. Specifically, we recorded electrocardiogram and impedance cardiogram, from which we derived heart rate, respiration rate, measures of high-frequency heart rate variability (indices of parasympathetic autonomic nervous system activity), and ventricular contractility (an index of sympathetic autonomic nervous system activity). Our methods produced physiologically plausible data, and further, animals with increased heart rates during testing were also more reactive to isolation from their social partner and presentation of novel objects, though no relationship was observed between reactivity and specific indices of parasympathetic or sympathetic nervous system activity.

Anatomical study of the ventral rami of thoracic spinal nerves in Sapajus apella (Primates: Cebidae)

This study aimed to describe the gross anatomy of the ventral rami of the thoracic spinal nerves in capuchin monkey (Sapajus apella) and compare with humans and other primate species. Eight specimens, prepared in 10% formalin solution and dissected following routine standard techniques, were used. The animals presented 13-14 pairs of thoracic spinal nerves emerging from the intervertebral foramen and divided into dorsal and ventral rami. The ventral rami of the first 12 or 13 pairs represented intercostal nerves and the latter referred to the subcostal nerve. The intercostal and subcostal nerves gave off muscular and cutaneous branches (lateral and ventral), which promote innervation of muscles and skin associated with the chest and abdominal wall. Atypical anatomy was verified for the 1st, 2nd and 7th to 13th intercostal nerves as well as for the subcostal nerve. The morphological characteristics were similar to those observed in humans and some non-human primates, especially in the absence of collateral branches.

Developmental Morphology and Topography of the Components of the Cervical Sympathetic Trunk in Sheep (Ovis aries) During the Fetal Period

The objective of this study was to clarify the typical architecture and morphological variations of cervical sympathetic trunk (CST) in sheep during fetal period. Components of CST were examined on both sides of 40 male and female sheep fetuses aged from 60 to 140 days under a stereomicroscope. Skeletotopy and frequency of presence of cranial cervical ganglion (CCG), syntopy of cervical ganglia, and composition and topography of vagosympathetic trunk were consistent among specimens whereas the shape of cervical ganglia, the skeletotopy and number of three middle cervical ganglia (MG), and the frequency of communicating branches of CCG to the first cervical spinal nerve exhibited differences during fetal period. A reduction in the number of MG and the caudal movement of main MG were noted by increasing fetal age. Based on these detailed findings, comparative and developmental anatomy and evolutionary changes are discussed and compared with previous studies. The number of MG, skeletotopy of CCG and main MG, the number and range of communicating branches of CCG to spinal nerves, and the association of vagus and sympathetic nerves in fetal sheep were fundamentally different from those of mostly reported species. These results suggest that data obtained from CST of fetal sheep are significantly different from those obtained from humans, and it is problematic to apply them to humans because of the more cranial position of CCG, very narrow contribution of CCG to spinal nerve, absence of the vertebral ganglion, existence of multiple MG, and no communicating branches from MG to spinal nerves. Anat Rec, 300:2250-2262, 2017. © 2017 Wiley Periodicals, Inc.

Determination of vertebral heart score in Goeldi's monkeys (Callimico goeldii)

BACKGROUND

Goeldi's monkeys (Callimico goeldii) are callitrichid primates commonly kept in zoological collections, and to date, no cardiac parameters have been recorded. The vertebral heart score (VHS) is an objective method of evaluation of cardiac size well documented in domestic mammals, and the aim of this study was to determine the VHS in Goeldi's monkeys.

METHODS

In this retrospective study, right lateral radiographs of thirteen clinically well animals were reviewed and vertebral heart score determined.

RESULTS

The vertebral heart score was found to be 9.35 ± 0.31.

CONCLUSIONS

The observed value appears consistent within the study population and with values for other primate species. The value determined may be of benefit in objectively evaluating cardiac size in this species.

Detailed comparative anatomy of the extrinsic cardiac nerve plexus and postnatal reorganization of the cardiac position and innervation in the great apes: orangutans, gorillas, and chimpanzees

To speculate how the extrinsic cardiac nerve plexus (ECNP) evolves phyletically and ontogenetically within the primate lineage, we conducted a comparative anatomical study of the ECNP, including an imaging examination in the great apes using 20 sides from 11 bodies from three species and a range of postnatal stages from newborns to mature adults. Although the position of the middle cervical ganglion (MG) in the great apes tended to be relatively lower than that in humans, the morphology of the ECNP in adult great apes was almost consistent with that in adult humans but essentially different from that in the lesser apes or gibbons. Therefore, the well-argued anatomical question of when did the MG acquire communicating branches with the spinal cervical nerves and appear constantly in all sympathetic cardiac nerves during primate evolution is clearly considered to be after the great apes and gibbons split. Moreover, a horizontal four-chambered heart and a lifted cardiac apex with a relatively large volume in newborn great apes rapidly changed its position downward, as seen in humans during postnatal growth and was associated with a reduction in the hepatic volume by imaging diagnosis and gross anatomy. In addition, our observation using a range of postnatal stages exhibits that two sympathetic ganglia, the middle cervical and cervicothoracic ganglia, differed between the early and later postnatal stages.

Anatomy of the cardiac nervous system with clinical and comparative morphological implications

Unlike autonomic nervous preservation in other surgeries for improving patient quality of life, autonomic cardiac nervous system (ACNS) preservation has been neglected in cardiovascular surgery because of technical difficulties and other unsolved issues. Because such ACNS preservation in cardiovascular surgery is anticipated in the future, detailed anatomical investigation of the human ACNS is required. Therefore, we have conducted morphological studies of the ACNS from macroscopic, clinical, and evolutionary anatomical viewpoints. In this study, I review detailed anatomical studies of the human ACNS together with their clinical implications. In addition, the evolutionary comparative anatomical significance of primate ACNS is also summarized to help understand and translate the findings of functional experiments to humans. These integrated findings will be the subject of a future study unifying molecular embryological and anatomical findings to clarify cardiac functions based on functional animal experiments, clinical applications such as improving surgery techniques and individual order-made surgery in cardiac surgery, and for future evaluation in regenerative medicine.