(Circulation. 1999;99:1866-1871.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Serial Assessment of Sympathetic Reinnervation After Orthotopic Heart Transplantation
A Longitudinal Study Using PET and C-11 Hydroxyephedrine
From Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München (F.M.B., S.I.Z., S.N., M.S.); Herzchirurgische Klinik der Ludwig-Maximilians Universität München (P.U., B.R.); Munich, Germany
Correspondence to Frank M. Bengel, MD, Nuklearmedizinische Klinik und Poliklinik, Technische Universität München, Klinikum Rechts der Isar, Ismaninger Strasse 22, 81675 Munich, Germany. E-mail frank.bengel{at}lrz.tu-muenchen.de
Background—Little is known about the progressiveness of sympathetic reinnervation late after cardiac transplantation (HTX). The aim of the present study was to describe individual growth of sympathetic terminals after HTX by a longitudinal quantitative assessment.
Methods and Results—In 20 patients after HTX, dynamic PET with C-11 hydroxyephedrine (HED) was performed twice within 3.0±0.5 years. According to the time interval between HTX and first PET, subgroups of patients early (group A, <1.5 years; n=7), intermediate (group B, 1.5 to 7 years; n=7) and late (group C, >7 years; n=6) after HTX were defined. At the time of first HED PET, 10 patients were completely denervated (7 in group A, 2 in group B, and 1 in group C). Only 3 remained denervated at second PET. A significant increase of reinnervated myocardium between first and second PET was found in all 3 groups (0% to 9±9% of left ventricle for group A, P<0.05; 13±12% to 23±17% for group B, P<0.05; 21±21% to 37±23% for group C, P<0.05). The magnitude of increase was similar between groups. Reinnervation was first surveyed in the basal anterior region, then toward apex, septal, and lateral wall. Inferior wall remained denervated. The largest reinnervated area surveyed in an individuum was 66% of the left ventricle.
Conclusions—The present data confirm the low likelihood of sympathetic reinnervation within 18 months after HTX. Once the reinnervation process is initiated, a continuous growth is observed even late after HTX, suggesting a progressive nature of reinnervation. Reinnervation, however, remained regionally heterogeneous, and a complete restoration was not found until 15 years after HTX.
Key Words: transplantation • nervous system, autonomic • positron emission tomography
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