Circulation, Vol 83, 1210-1220, Copyright © 1991 by American Heart Association
RF Wilson, BV Christensen, MT Olivari, A Simon, CW White and DD Laxson
BACKGROUND. Cardiac transplantation (CT) causes total cardiac denervation.
METHODS AND RESULTS. To test directly for sympathetic reinnervation in
humans, we measured the cardiac release of norepinephrine (NE) in response
to tyramine (an agent that causes NE release from intact sympathetic nerve
terminals) and sustained handgrip exercise (a reflex sympathetic stimulus)
in 12 patients less than 5 months after CT, in 50 patients 1 year or more
after CT, and in eight patients without CT. Plasma [NE] was measured in the
aorta [( NE]Ao) and coronary sinus [( NE]CS) at rest, after tyramine
administration (55 micrograms/kg, i.v.), and during sustained handgrip
exercise. Cardiac NE release was determined by subtracting [NE]Ao from
[NE]CS [( NE]CS- Ao). NE release was defined as [NE]CS-Ao during the
intervention-[NE]CS- Ao at rest (delta [NE]CS-Ao). In patients studied
within 5 months of CT, no significant NE release occurred after tyramine
administration (delta [NE]CS-Ao, 33 +/- 18 pg/ml; range, -98 to 117 pg/ml)
or handgrip exercise (delta [NE]CS-Ao, -34 +/- 10 pg/ml; range, -46 to 8
pg/ml; n = 10). Conversely, in 39 of 50 patients studied 1 year or more
after CT, tyramine administration caused a significant cardiac NE release
(delta [NE]CS-Ao, 500 +/- 59 pg/ml; range, -11 to 1,918 pg/ml), and
handgrip exercise caused a significant NE release in 17 of 41 patients
(delta [NE]CS-Ao, 189 +/- 34 pg/ml; range, -211 to 949 pg/ml). In normally
innervated patients, tyramine caused an even larger NE release (delta
[NE]Ao-CS, 1,943 +/- 210 pg/ml; range, 1,152 to 2,977 pg/ml), and handgrip
exercise caused a significant NE release in two of seven patients (delta
[NE]CS-Ao, 143 +/- 51 pg/ml; range, -15 to 338 pg/ml). CONCLUSIONS. Early
after CT, neither tyramine nor handgrip exercise caused a significant
cardiac release of NE, suggesting sympathetic denervation. Late after CT,
most patients had a significant, but subnormal, NE release in response to
pharmacological or reflex stimuli, suggesting that limited sympathetic
reinnervation occurs in most patients after orthotopic CT.
ARTICLES
Evidence for structural sympathetic reinnervation after orthotopic cardiac transplantation in humans
Department of Medicine, University of Minnesota, Minneapolis.
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