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Effect of Sympathetic Reinnervation on Cardiac Performance After Heart Transplantation F.M. Bengel, P. Ueberfuhr, N Schiepel,
S.G. Nekolla, B. Reichart, M. Schwaiger. N Engl J Med 2001;
345: 731-8.
Background: Limited reinnervation of the heart may occur late after cardiac transplantation. Little has been known about the effect of reinnervation on exercise performance or cardiac function. Methods: Twenty-nine patients who had undergone cardiac transplantation were studied. Positron-emission tomography and C-11 labeled hydroxyephedrine, a catecholamine analogue, were used to determine the degree of reinnervation that had occurred. Radionuclide angiography was used to determine global and regional ventricular function at rest and during standardized exercise testing. The results from these patients were compared to those from 10 healthy controls. Results: Sympathetic reinnervation was present in 16 of the 29 patients who had undergone transplantation. It was mainly in the anteroseptal wall. There were no hemodynamic differences between these 2 groups at rest. However, patients with sympathetic reinnervation had higher peak exercise heart rates (mean 143 +/- 15 vs. 121 +/- 13 (SD), P <0.01). They also had a longer mean exercise time (8.2 +/- 1.2 minutes vs. 6.1 +/- 1.5 minutes, P < 0.01). Finally, they had significantly improved contractile response to exercise, similar to that of the healthy control group. Conclusions: The authors concluded that heart-transplant recipients who had restoration of sympathetic innervation had improved response to exercise as measured by heart rate and contractile function. Comments: The group of transplant recipients who had evidence of sympathetic innervation had undergone transplantation earlier, and had hearts from younger donors, than those who did not have evidence of reinnervation. Obviously, however, no potential recipient of a heart transplant would refuse the organ merely because the donor was elderly. The practical value of this paper for us may be in evaluating perioperative risk of patients who have undergone cardiac transplantation. While our anesthetic management of these patients should require little more than their performance at rest, their ability to increase heart rate and contractility could be very important in the more stressful postoperative period. It would be wonderful if something could be done to enhance reinnervation for these patients. They are a tiny population, so such advances would likely come from the work and support of those with non-commercial interests, such as us. Table of Contents
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