This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bengel, F. M. Articles by Schwaiger, M. Search for Related Content PubMed PubMed Citation Articles by Bengel, F. M. Articles by Schwaiger, M. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information Heart Transplantation Related Collections Nuclear cardiology and PET CV surgery: transplantation, ventricular assistance, cardiomyopathy

(Circulation. 2001;103:1881.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Myocardial Efficiency and Sympathetic Reinnervation After Orthotopic Heart Transplantation

A Noninvasive Study With Positron Emission Tomography

Frank M. Bengel, MD; Peter Ueberfuhr, MD; Nina Schiepel, MS; Stephan G. Nekolla, PhD; Bruno Reichart, MD; Markus Schwaiger, MD

From Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München (F.M.B., N.S., S.G.N., M.S.) and Herzchirurgische Klinik der Ludwig-Maximilians Universität München (P.U., B.R.), Munich, Germany.

Correspondence to Frank M. Bengel, MD, Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München, Klinikum rechts der Isar, Ismaninger Str 22, 81675 München, Germany. E-mail frank.bengel{at}lrz.tu-muenchen.de

Background—The lack of cardiac catecholamine uptake and storage caused by sympathetic denervation may influence performance of the transplanted heart. Reinnervation, occurring late after transplantation, may partially resolve these effects. In this study, oxidative metabolism and its relation to cardiac work were compared in allografts and normal and failing hearts, and the effects of sympathetic reinnervation were evaluated.

Methods and Results—Twenty-seven nonrejecting, symptom-free transplant recipients, 11 healthy control subjects, and 10 patients with severe dilated cardiomyopathy underwent PET with ¹¹C acetate for assessment of oxidative metabolism by the clearance constant k(mono) and radionuclide angiography or MRI for measurement of ventricular function, geometry, and work. Efficiency was estimated noninvasively by a work-metabolic index [WMI=(stroke volumexheart ratexsystolic pressure)/k(mono)]. In 14 of 27 transplants, presence of regional reinnervation was identified with PET and the catecholamine analogue ¹¹C hydroxyephedrine (extent, 24±14% of left ventricle). The WMI was comparable in normal subjects and reinnervated and denervated transplants (6.2±2.3 versus 4.9±2.0 versus 4.9±1.2 · 10⁶ mm Hg · mL; P=NS) and significantly lower in cardiomyopathy patients (3.0±1.3 · 10⁶ mm Hg · mL; P<0.001). For normal subjects and transplant recipients, the WMI was significantly correlated with afterload (peripheral vascular resistance; r=-0.65, P<0.01), preload (end-diastolic volume; r=0.78, P<0.01), and stroke volume (r=0.81, P<0.01) but not with hydroxyephedrine retention (transplants only; r=0.09, P=NS).

Conclusions—After transplantation, cardiac efficiency is improved compared with failing hearts and comparable to normal hearts. Differences between denervated and reinnervated allografts were not surveyed. Additionally, the dependency on loading conditions and contractility was preserved, suggesting that normal regulatory interactions for efficiency are intact and that sympathetic tone does not play a role under resting conditions.

Key Words: transplantation • myocardium • nervous system, sympathetic • tomography

This article has been cited by other articles:

				A. L. Fellet, A. M. Balaszczuk, C. Arranz, J. J. Lopez-Costa, A. Boveris, and J. Bustamante Autonomic regulation of pacemaker activity: role of heart nitric oxide synthases Am J Physiol Heart Circ Physiol, September 1, 2006; 291(3): H1246 - H1254. [Abstract] [Full Text] [PDF]

				F. M. Bengel, P. Ueberfuhr, J. Karja, K. Schreiber, S. G. Nekolla, B. Reichart, and M. Schwaiger Sympathetic reinnervation, exercise performance and effects of {beta}-adrenergic blockade in cardiac transplant recipients Eur. Heart J., October 1, 2004; 25(19): 1726 - 1733. [Abstract] [Full Text] [PDF]

				F. M. Bengel, P. Ueberfuhr, T. Hesse, N. Schiepel, S. I. Ziegler, S. Scholz, S. G. Nekolla, B. Reichart, and M. Schwaiger Clinical Determinants of Ventricular Sympathetic Reinnervation After Orthotopic Heart Transplantation Circulation, August 13, 2002; 106(7): 831 - 835. [Abstract] [Full Text] [PDF]

				F. M. Bengel, P. Ueberfuhr, N. Schiepel, S. G. Nekolla, B. Reichart, and M. Schwaiger Effect of Sympathetic Reinnervation on Cardiac Performance after Heart Transplantation N. Engl. J. Med., September 6, 2001; 345(10): 731 - 738. [Abstract] [Full Text] [PDF]