Document Detail


Effect of sympathetic reinnervation on cardiac performance after heart transplantation.
MedLine Citation:
PMID:  11547742     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Late after cardiac transplantation, limited reinnervation of the transplanted heart may occur, but little is known about the effect of reinnervation on cardiac function and exercise performance. METHODS: We quantified the extent of myocardial reinnervation noninvasively in 29 cardiac-transplant recipients, using positron-emission tomography and the catecholamine analogue [11C]hydroxyephedrine. Global and regional ventricular function at rest and during standardized exercise testing were measured with the use of radionuclide angiography, and the results were compared with those in 10 healthy controls. RESULTS: Sympathetic reinnervation, mainly in the anteroseptal wall, was present in 16 of the 29 transplant recipients. At rest, hemodynamic differences were not observed between the patients with reinnervation and those with denervation. However, the latter group had a shorter mean (+/-SD) exercise time (6.1+/-1.5, minutes vs. 8.2+/-1.2 in the group with reinnervation; P<0.01) and a lower peak heart rate (121+/-13 vs. 143+/-15 beats per minute, P<0.01). The contractile response to exercise was significantly enchanced in transplant recipients with reinnervation and similar to that of normal controls. In a multivariate analysis, hydroxyephedrine retention was the only independent determinant of the exercise-induced increase in the ejection fraction. CONCLUSIONS: In heart-transplant recipients, the restoration of sympathetic innervation is associated with improved responses of the heart rate and contractile function to exercise. These results support the functional importance of reinnervation in transplanted hearts.
Authors:
F M Bengel; P Ueberfuhr; N Schiepel; S G Nekolla; B Reichart; M Schwaiger
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The New England journal of medicine     Volume:  345     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2001 Sep 
Date Detail:
Created Date:  2001-08-24     Completed Date:  2001-09-13     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  731-8     Citation Subset:  AIM; IM    
Affiliation:
Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München, Klinikum rechts der Isar, Germany. frank.bengel@lrz.tu-muenchen.de
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MeSH Terms
Descriptor/Qualifier:
Carbon Radioisotopes / diagnostic use
Catecholamines / blood
Ephedrine / analogs & derivatives*,  diagnostic use
Exercise / physiology
Exercise Test
Exercise Tolerance
Female
Heart / innervation*,  physiology*,  radionuclide imaging
Heart Rate
Heart Transplantation / physiology*
Humans
Middle Aged
Nerve Regeneration / physiology*
Stroke Volume
Sympathetic Nervous System*
Tomography, Emission-Computed
Ventricular Function, Left
Chemical
Reg. No./Substance:
0/Carbon Radioisotopes; 0/Catecholamines; 299-42-3/Ephedrine; 3002-40-2/3-hydroxyephedrine
Comments/Corrections
Comment In:
N Engl J Med. 2001 Sep 6;345(10):762-4   [PMID:  11547748 ]
N Engl J Med. 2001 Dec 27;345(26):1914-5   [PMID:  11756586 ]
N Engl J Med. 2001 Dec 27;345(26):1915   [PMID:  11794319 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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