neuropeptide-y and Cardiomyopathy--Hypertrophic

A novel method of cardiac denervation by cryoablation has been developed experimentally. The technique uses liquid nitrogen delivered under pressure to ablate the principal sources of cardiac innervation--namely, the adventitia surrounding the aorta, pulmonary arteries, and veins. The technique has been verified experimentally both in vivo by physiological means and in vitro by quantitative immunohistochemistry and the measurement of myocardial noradrenaline concentrations. A 35 year old woman presented with intractable precordial pain, normal epicardial coronary arteries, and hypertrophic cardiomyopathy. Her symptoms were refractory to maximal medical treatment and she was thought to be unsuitable for either conventional myocardial revascularisation, autotransplantation, or allografting with the concomitant risk of transplant coronary artery disease. She therefore underwent cardiac denervation by the method developed in the laboratory. There was quantitative immunohistochemical evidence of extrinsic cardiac denervation associated with a considerable improvement in her symptoms. This improvement persisted during a follow up period of over 16 months.

Topics: Adult; Cardiomyopathy, Hypertrophic; Chest Pain; Cryosurgery; Denervation; Female; Heart; Humans; Immunohistochemistry; Myocardium; Neuropeptide Y; Pain, Intractable; Thiolester Hydrolases; Ubiquitin Thiolesterase

1. Family and population studies have reported that blood pressure has a heritability of 30-50%, but simple genetic models do not readily explain the patterns of inheritance of hypertension. 2. Restriction fragment length polymorphisms were used to study allele frequencies of a selection of candidate genes that may be important in determining the genetic component of hypertension. These included the genes for renin, haptoglobin, neuropeptide Y and cardiac myosin beta heavy chain. 3. There was no significant association between alleles at any of these loci and the presence of hypertension in this population, suggesting that the contribution of variation at these loci to the genetic component of the variance in hypertension may be quite small.

Topics: Alleles; Cardiomyopathy, Hypertrophic; Chromosomes, Human, Pair 1; Chromosomes, Human, Pair 14; Chromosomes, Human, Pair 7; DNA; DNA Probes; Female; Genetic Linkage; Haptoglobins; Humans; Hypertension; Male; Middle Aged; Myosins; Neuropeptide Y; Nucleic Acid Hybridization; Polymorphism, Genetic; Polymorphism, Restriction Fragment Length; Renin