2
|
Yu L, Li X, Huang B, Zhou X, Wang M, Zhou L, Meng G, Wang Y, Wang Z, Deng J, Jiang H. Atrial Fibrillation in Acute Obstructive Sleep Apnea: Autonomic Nervous Mechanism and Modulation. J Am Heart Assoc 2017; 6:JAHA.117.006264. [PMID: 28903938 PMCID: PMC5634281 DOI: 10.1161/jaha.117.006264] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background The mechanisms of atrial fibrillation (AF) induced by obstructive sleep apnea (OSA) are not completely understood. This study investigated the roles of the intrinsic and extrinsic cardiac autonomic nervous system in OSA‐induced AF and provided noninvasive autonomic nervous modulation for the suppression of OSA‐induced AF by using low‐level transcutaneous electrical stimulation (LL‐TS) of the auricular branch of the vagus nerve at the tragus. Methods and Results Eighteen dogs received tracheostomy under general anesthesia and were randomly divided into 3 groups: the OSA group (OSA was simulated via clamping of the endotracheal tube at end expiration for 1.5 minutes every 10 minutes, n=6), the LL‐TS + OSA group (simulated OSA plus LL‐TS, at 80% of the slowing sinus rate, n=6), and the control group (sham surgery without stimulation, n=6). The effective refractory period was significantly shortened after 1 hour of simulated OSA, and the window of vulnerability and plasma norepinephrine levels were both markedly increased in the OSA group. OSA dramatically increased the neural function and activity of the intrinsic and extrinsic cardiac autonomic nervous system, including the superior left ganglionated plexus, the left stellate ganglion, and the left renal sympathetic nerve. OSA also significantly upregulated the expression levels of c‐fos and nerve growth factor in the superior left ganglionated plexus and the left stellate ganglion. However, LL‐TS markedly improved these parameters. Conclusions These findings suggest that the intrinsic and extrinsic cardiac autonomic nervous system plays crucial roles in the acute stage of OSA‐induced AF. Noninvasive LL‐TS suppressed shortening of atrial refractoriness and autonomic remodeling, which prevented OSA‐induced AF.
Collapse
Affiliation(s)
- Lilei Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China .,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Xuefei Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Bing Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Xiaoya Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Menglong Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Liping Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Guannan Meng
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Yuhong Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Zhenya Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Jielin Deng
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China .,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| |
Collapse
|
3
|
Uzuka H, Matsumoto Y, Nishimiya K, Ohyama K, Suzuki H, Amamizu H, Morosawa S, Hirano M, Shindo T, Kikuchi Y, Hao K, Shiroto T, Ito K, Takahashi J, Fukuda K, Miyata S, Funaki Y, Ishibashi-Ueda H, Yasuda S, Shimokawa H. Renal Denervation Suppresses Coronary Hyperconstricting Responses After Drug-Eluting Stent Implantation in Pigs In Vivo Through the Kidney-Brain-Heart Axis. Arterioscler Thromb Vasc Biol 2017; 37:1869-1880. [PMID: 28818859 DOI: 10.1161/atvbaha.117.309777] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 08/02/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Drug-eluting stent-induced coronary hyperconstricting responses remain an important issue. The adventitia harbors a variety of components that potently modulate vascular tone, including sympathetic nerve fibers (SNF) and vasa vasorum. Catheter-based renal denervation (RDN) inhibits sympathetic nerve activity. We, thus, examined whether RDN suppresses drug-eluting stent-induced coronary hyperconstricting responses, and if so, what mechanisms are involved. APPROACH AND RESULTS Protocol 1: pigs implanted with everolimus-eluting stents into the left coronary arteries underwent coronary angiography at 1 month after implantation for assessment of coronary vasomotion and adventitial SNF formation. Drug-eluting stent-induced coronary hyperconstricting responses were significantly enhanced associated with enhanced coronary adventitial SNF and vasa vasorum formation. Protocol 2: pigs implanted with everolimus-eluting stents were randomly assigned to the RDN or sham group. The RDN group underwent renal ablation. At 1 month, RDN significantly caused marked damage of the SNF at the renal arteries without any stenosis, thrombus, or dissections. Notably, RDN significantly upregulated the expression of α2-adrenergic receptor-binding sites in the nucleus tractus solitarius, attenuated muscle sympathetic nerve activity, and decreased systolic blood pressure and plasma renin activity. In addition, RDN attenuated coronary hyperconstricting responses to intracoronary serotonin at the proximal and distal stent edges associated with decreases in SNF and vasa vasorum formation, inflammatory cell infiltration, and Rho-kinase expression/activation. Furthermore, there were significant positive correlations between SNF and vasa vasorum and between SNF and coronary vasoconstricting responses. CONCLUSIONS These results provide the first evidence that RDN ameliorates drug-eluting stent-induced coronary hyperconstricting responses in pigs in vivo through the kidney-brain-heart axis.
Collapse
Affiliation(s)
- Hironori Uzuka
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yasuharu Matsumoto
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kensuke Nishimiya
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuma Ohyama
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hideaki Suzuki
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hirokazu Amamizu
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Susumu Morosawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Michinori Hirano
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tomohiko Shindo
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoku Kikuchi
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kiyotaka Hao
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takashi Shiroto
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenta Ito
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Jun Takahashi
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Koji Fukuda
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Miyata
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihito Funaki
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hatsue Ishibashi-Ueda
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Yasuda
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroaki Shimokawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan.
| |
Collapse
|