This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wilson, R. F. Articles by Mianuelli, M. Search for Related Content PubMed PubMed Citation Articles by Wilson, R. F. Articles by Mianuelli, M. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB EPINEPHRINE Medline Plus Health Information Heart Transplantation Related Collections Exercise testing Other diagnostic testing CV surgery: transplantation, ventricular assistance, cardiomyopathy Autonomic, reflex, and neurohumoral control of circulation

(Circulation. 2000;101:2727.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Sympathetic Reinnervation of the Sinus Node and Exercise Hemodynamics After Cardiac Transplantation

Robert F. Wilson, MD; Thomas H. Johnson, MD; George C. Haidet, MD¹; Spencer H. Kubo, MD; Marcus Mianuelli, MS

From the Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minn.

Correspondence to Robert F. Wilson, Box 508, UMHC, 420 Delaware St SE, Minneapolis, MN 54455.

Background—Sympathetic cardiac reinnervation occurs variably after cardiac transplantation (CT) in humans. We hypothesized that sinus node reinnervation would partially restore normal chronotropic response to exercise.

Methods and Results—Thirteen recent CT recipients, 28 late CT recipients (1 year after CT), and 20 control subjects were studied. Sinus node sympathetic reinnervation was determined by heart rate (HR) change after tyramine injection into the artery that perfused the sinus node. HR changes of <5 and 15 bpm were defined, respectively, as denervation and marked reinnervation. During treadmill exercise, HR, blood pressure, and expired O₂ and CO₂ were measured. All early transplant recipients exhibited features typical of denervation (basal HR, 88±2 bpm; peak HR, 132±4 bpm, peaking 1.8±0.3 minutes after exercise cessation and slowly declining after exercise). A similar pattern was found in the 12 late transplant recipients with persistent sinus node denervation. However, in patients with marked reinnervation, exercise HR rose more (peak HR, 142±4 and 141±2 bpm), peaked earlier after cessation of exercise (0.7±0.4 and 0.3±0.1 minute), and fell more rapidly. Exercise duration and maximal oxygen consumption were not related significantly to reinnervation status, but a trend existed for longer exercise time in markedly reinnervated patients.

Conclusions—The present studies suggest that sympathetic reinnervation of the sinus node is accompanied by partial restoration of normal HR response to exercise. Both maximal oxygen consumption and exercise duration were markedly shorter in CT patients than in control subjects, and most of the difference was not related to innervation status.

Key Words: surgery • transplantation • tests • nervous system, sympathetic • exercise • cardiovascular diseases • reflex

This article has been cited by other articles:

				J. M. Scott, B. T. A. Esch, M. J. Haykowsky, D. E. R. Warburton, M. Toma, A. Jelani, D. Taylor, I. Paterson, D. Poppe, Y. Liang, et al. Cardiovascular responses to incremental and sustained submaximal exercise in heart transplant recipients Am J Physiol Heart Circ Physiol, February 1, 2009; 296(2): H350 - H358. [Abstract] [Full Text] [PDF]

				M. Mabuchi, M. Imamura, N. Kubo, K. Morita, K. Noriyasu, T. Tsukamoto, K. Yasuda, and N. Tamaki Sympathetic Denervation and Reinnervation After the Maze Procedure J. Nucl. Med., July 1, 2005; 46(7): 1089 - 1094. [Abstract] [Full Text] [PDF]

				F. M. Bengel, P. Ueberfuhr, J. Karja, K. Schreiber, S. G. Nekolla, B. Reichart, and M. Schwaiger Sympathetic reinnervation, exercise performance and effects of {beta}-adrenergic blockade in cardiac transplant recipients Eur. Heart J., October 1, 2004; 25(19): 1726 - 1733. [Abstract] [Full Text] [PDF]

				S. S. Lovric, V. Avbelj, R. Trobec, D. Zorman, P. Rakovec, S. Hojker, B. Gersak, and M. Milcinski Sympathetic reinnervation after heart transplantation, assessed by iodine-123 metaiodobenzylguanidine imaging, and heart rate variability Eur. J. Cardiothorac. Surg., October 1, 2004; 26(4): 736 - 741. [Abstract] [Full Text] [PDF]

				R. W. Squires, T.-C. Leung, N. S. Cyr, T. G. Allison, B. D. Johnson, K. V. Ballman, J. A. Wagner, L. J. Olson, R. P. Frantz, B. S. Edwards, et al. Partial Normalization of the Heart Rate Response to Exercise After Cardiac Transplantation: Frequency and Relationship to Exercise Capacity Mayo Clin. Proc., December 1, 2002; 77(12): 1295 - 1300. [Abstract] [PDF]

				F. M. Bengel, P. Ueberfuhr, T. Hesse, N. Schiepel, S. I. Ziegler, S. Scholz, S. G. Nekolla, B. Reichart, and M. Schwaiger Clinical Determinants of Ventricular Sympathetic Reinnervation After Orthotopic Heart Transplantation Circulation, August 13, 2002; 106(7): 831 - 835. [Abstract] [Full Text] [PDF]

				P. van de Borne, J. Neubauer, M. Rahnama, J.-L. Jansens, N. Montano, A. Porta, V. K. Somers, and J. P. Degaute Differential Characteristics of Neural Circulatory Control: Early Versus Late After Cardiac Transplantation Circulation, October 9, 2001; 104(15): 1809 - 1813. [Abstract] [Full Text] [PDF]

				F. M. Bengel, P. Ueberfuhr, N. Schiepel, S. G. Nekolla, B. Reichart, and M. Schwaiger Effect of Sympathetic Reinnervation on Cardiac Performance after Heart Transplantation N. Engl. J. Med., September 6, 2001; 345(10): 731 - 738. [Abstract] [Full Text] [PDF]

				D. J. Christini, J. Walden, and J. M. Edelberg Direct biologically based biosensing of dynamic physiological function Am J Physiol Heart Circ Physiol, May 1, 2001; 280(5): H2006 - H2010. [Abstract] [Full Text] [PDF]

				F. M. Bengel, P. Ueberfuhr, N. Schiepel, S. G. Nekolla, B. Reichart, and M. Schwaiger Myocardial Efficiency and Sympathetic Reinnervation After Orthotopic Heart Transplantation : A Noninvasive Study With Positron Emission Tomography Circulation, April 10, 2001; 103(14): 1881 - 1886. [Abstract] [Full Text] [PDF]