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Titolo:
Incomplete sympathic reinnervation of the orthotopically transplanted human heart: Observation up to 13 years after heart transplantation
Autore:
Uberfuhr, P; Ziegler, S; Schwaiblmair, M; Reichart, B; Schwaiger, M;
Indirizzi:
Univ Munich, Grosshadern Med Ctr, Clin Cardiac Surg, D-80539 Munich, Germany Univ Munich Munich Germany D-80539 Cardiac Surg, D-80539 Munich, Germany
Titolo Testata:
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
fascicolo: 2, volume: 17, anno: 2000,
pagine: 161 - 168
SICI:
1010-7940(200002)17:2<161:ISROTO>2.0.ZU;2-C
Fonte:
ISI
Lingua:
ENG
Soggetto:
POSITRON EMISSION TOMOGRAPHY; CARDIAC TRANSPLANTATION; EXERCISE CAPACITY; RECIPIENTS;
Keywords:
heart transplantation; sympathetic reinnervation; exercise testing; positron emission tomography; time course; transplant vasculopathy;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
35
Recensione:
Indirizzi per estratti:
Indirizzo: Uberfuhr, P Univ Munich, Grosshadern Med Ctr, Clin Cardiac Surg, D-80539 Munich, Germany Univ Munich Munich Germany D-80539 , D-80539 Munich, Germany
Citazione:
P. Uberfuhr et al., "Incomplete sympathic reinnervation of the orthotopically transplanted human heart: Observation up to 13 years after heart transplantation", EUR J CAR-T, 17(2), 2000, pp. 161-168

Abstract

Objective: Heart transplantation (HTx) is associated with autonomic denervation of the donor heart. Sympathetic reinnervation (RI) as defined by the presence of functional nerve terminals occurs only if sympathetic ganglia outside the heart are connected with nerve terminals in the transplanted heart. The purpose of this study was to define the incidence and functional consequences of RI over time after HTx. The activity and distribution of norepinephrine (NE) uptake sites were assessed by positron emission tomography (PET) imaging. Symptom limited exercise testing was performed by bicycle-ergometer. Methods: Forty-seven patients (m:f = 42:5, 47.6 +/- 8.2 years, agerange 27-65 years) were investigated between 2 months and 13.6 years afterHTx using PET and the NE analogue C-11-hydroxyephedrine (HED). Tracer uptake was quantified using dynamic imaging protocols yielding regional HED retention fraction. A regional value above 7%/min (+/-2.5 SD above the mean value of denervated hearts) was considered evidence for RI. The functional significance of RI was investigated in 34 patients (m:f = 30:4, 49.3 +/- 8.4 age range 27-62 years) by symptom limited exercise testing. Cardiac catheterization was performed at the time of PET imaging. Results: RI could not beassessed in the first year after HTx, in 11% in the second year and in 80%of the patients from the third year on. Retention values plateaued then. In all time intervals, beyond the third year, not reinnervated patients werefound. RI remained incomplete and was always restricted to the anterior wall of the left ventricle. Extent of retention of the left ventricle revealed a large individual range up to 66%, averaging of 20%. Recipient age at the time of HTx, reinnervated patients were 5.5 years younger than not reinnervated ones, proved as the only significant influencing factor for RI (P < 0.05). Dividing patients into scintigraphically reinnervated (n = 20) and not reinnervated (n = 14), reinnervated patients displayed during exercise ahigher maximal heart rate (137 +/- 14 vs. 123 +/- 20/ min, P < 0.05), heart rate increase (40 +/- 15 vs. 28 +/- 13/min, P < 0.05), max. oxygen consumption (1674 +/- 424 vs. 1279 +/- 308 ml/min, P < 0.01) and anaerobic threshold (887 +/- 170 vs. 717 +/- 183 mlO(2)/min, P < 0.01) than not reinnervated ones. A correlation between transplant vasculopathy and RI could not be demonstrated. Conclusion: RI assessed by PET and the NE analogue HED is timedependent, incomplete, displays a typical pattern and demonstrates a broadindividual spread. Furthermore, RI enhances functional parameters of exercise testing. (C) 2000 Elsevier Science B.V. All rights reserved.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 10/07/20 alle ore 09:21:57