Circulation, Vol 75, 914-921, Copyright © 1987 by American Heart Association
PK Mohanty, MD Thames, JA Arrowood, JR Sowers, C McNamara and S Szentpetery
There is ample evidence for efferent cardiac denervation in patients after
cardiac transplantation. However, little is known regarding the effects of
the cardiac deafferentation that also results. We examined responses to
graded lower-body negative pressure and thus cardiopulmonary baroreceptor
unloading in 23 patients 3 to 12 months after cardiac transplantation and
compared their responses with those of nine normal subjects. Responses of
mean arterial pressure, forearm vascular resistance, and plasma
norepinephrine were assessed during lower-body negative pressure and the
cold pressor test. Reflex increases in forearm vascular resistance (1.5 +/-
1, 5.0 +/- 1.4, and 6.4 +/- 2.1 vs 14.5 +/- 4.5, 20.3 +/- 6.5, and 34 +/-
11 units) and plasma norepinephrine (42 +/- 12, 58 +/- 15, and 62 +/- 13 vs
49 +/- 14, 94 +/- 25, and 173 +/- 36 pg/ml) during lower-body negative
pressure (at -10, -20, and -40 mm Hg) were strikingly smaller in cardiac
transplant patients than in normal subjects. The impaired responses of the
cardiac transplant patients were not the result of a nonspecific depression
of cardiovascular reflexes, since increases in mean arterial pressure (12
+/- 3 vs 10 +/- 2 mm Hg), forearm vascular resistance (19.5 +/- 3.4 vs 18
+/- 5.8 units), and plasma norepinephrine (56 +/- 8 vs 42 +/- 11 pg/ml)
during cold pressor test were not significantly different in the two
groups. Furthermore, the impaired responses were not caused by the
immunosuppressive agents used to treat the cardiac transplant patients,
since patients with renal transplants on similar regimens had augmented
forearm vasoconstrictor responses.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Impairment of cardiopulmonary baroreflex after cardiac transplantation in humans
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