Circulation, Vol 88, 1110-1118, Copyright © 1993 by American Heart Association
DM Kaye, M Esler, B Kingwell, G McPherson, D Esmore and G Jennings
BACKGROUND. The presence of cardiac reinnervation in humans after cardiac
transplantation has been widely debated, based on the application of
differing methods for the assessment of neuronal function. Some of these
techniques have been rather indirect; consequently, the time course and
extent of cardiac reinnervation remains uncertain. METHODS AND RESULTS. To
test for the presence of cardiac reinnervation after transplantation, we
examined neurochemical (radiolabeled norepinephrine [NE] kinetics) and
functional markers (power spectral analysis, heart rate response to
exercise) of cardiac sympathetic nerve integrity in 15 cardiac
transplantation recipients and 25 healthy control subjects of similar age.
Cardiac transplantation subjects were studied 9 weeks to 8 years after
cardiac transplantation (10 "early" patients < 18 months and 5 "late"
patients > 2 years after cardiac transplantation). At rest, cardiac NE
spillover was markedly attenuated early after transplantation (11.2 +/-
18.3 pmol/min) compared with subjects late after transplantation (105 +/-
11 pmol/min, P < .01) or in healthy control subjects (103 +/- 15
pmol/min, P < .01). Heart rate variability (measured by total spectral
power) was significantly reduced in cardiac transplantation recipients
compared with control subjects (59.4 +/- 30 vs 1673 +/- 516 milliseconds
squared; P < .05), with evidence of a trend toward increasing spectral
power late after transplantation. During exercise, the cardiac NE spillover
was significantly lower in early cardiac transplantation recipients when
compared with control subjects (163 +/- 50 vs 1876 +/- 418 pmol/min, P <
.01). Late cardiac transplantation subjects showed a response intermediate
(1080 +/- 254 pmol/min) between that of the early cardiac transplantation
and control groups. However, measurements of the neuronal reuptake process
for NE (assessed by the fractional extraction of plasma labeled NE across
the heart and tritiated dihydroxyphenylglycol release) were significantly
depressed in both early and late cardiac transplantation subjects.
CONCLUSIONS. The present study demonstrates a partial restoration of
cardiac sympathetic nerve function in humans up to 8 years after heart
transplantation.
ARTICLES
Functional and neurochemical evidence for partial cardiac sympathetic reinnervation after cardiac transplantation in humans
Alfred and Baker Medical Unit, Alfred Hospital, Prahran, Victoria, Australia.
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