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(Circulation. 2001;104:1809.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Differential Characteristics of Neural Circulatory Control

Early Versus Late After Cardiac Transplantation

Philippe van de Borne, MD PhD; Jolanta Neubauer, MD; Mohsen Rahnama, MD; Jean-Luc Jansens, MD; Nicola Montano, MD PhD; Alberto Porta, PhD; Virend K. Somers, MD DPhil; Jean Paul Degaute, MD PhD

From the Hypertension Clinic, Department of Cardiology (P.v.d.B., J.N., M.R., J.P.D.) and Department of Cardiac Surgery (J.-L.J.), Erasme Hospital, Belgium; Department of Internal Medicine (N.M., A.P.), Hospital L. Sacco, Milan, Italy; and Division of Hypertension and Division of Cardiovascular Diseases (V.K.S.), Mayo Clinic, Rochester, Minn.

Correspondence to Philippe van de Borne, MD, PhD, Hypertension Clinic, Department of Cardiology, Erasme Hospital, 808 Lennik Rd, 1070 Brussels, Belgium. E-mail pvandebo{at}ulb.ac.be

Background— Reappearance of low-frequency (LF) (±0.10 Hz) oscillations in RR interval (RR) after cardiac transplantation is indicative of sympathetic efferent reinnervation. We hypothesized that restored LF oscillations in RR in heart transplant recipients (HTRs) are linked to oscillations in muscle sympathetic nerve traffic (MSNA).

Methods and Results— RR, RR variability, and MSNA were recorded 5±2 months (n=7, short-term HTRs) and 138±8 months (n=7, long-term HTRs) after heart transplantation and compared with matched hypertensive patients (n=7). A coherence function determined the coupling between LF oscillations in MSNA and RR. RR variance did not differ between short-term and long-term HTRs. However, LF variability was only 1±0.5 ms² in the short-term HTRs but was 15±8 ms² in the long-term HTRs (P<0.05). Normalized LF variability was also higher in the long-term HTRs (40±14 normalized unites) versus the short-term HTRs (6±3 normalized united, P<0.05) but did not differ from the LF variability of the hypertensive patients. Long-term HTRs were taking less cyclosporine (P<0.01) but had higher MSNA than the short-term HTRs (62±7 versus 31±7 burst/min, respectively, P<0.05). Coherence between LF oscillations in MSNA and RR was similar in the long-term HTRs (0.59±0.11) and the hypertensive patients (0.60±0.07) and was 3-fold greater than in the short-term HTRs (0.20±0.06, P<0.05).

Conclusions— Cardiac reinnervation after long-term heart transplantation is characterized by a restoration of the coherence between LF oscillations in RR and MSNA. Higher MSNA in long-term than in short-term HTRs suggests that time elapsed after cardiac transplantation may be a major determinant of sympathetic excitation in heart transplant recipients.

Key Words: transplantation • nervous system, sympathetic • circulation

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