Circulation, Vol 88, 165-171, Copyright © 1993 by American Heart Association
RF Wilson, DD Laxson, BV Christensen, AL McGinn and SH Kubo
BACKGROUND. In the majority of humans > or = 1 year after cardiac
transplantation, cardiac norepinephrine (NE) stores reappear, suggesting
late sympathetic reinnervation. METHODS AND RESULTS. To determine whether
there are regional differences in reinnervation, we measured markers of
sympathetic reinnervation of the sinus node (SN) and left ventricle (LV) in
five early transplant recipients (< or = 4 months after cardiac
transplantation), 45 late transplant recipients (> or = 1 year after
cardiac transplantation), and seven normally innervated control patients.
SN reinnervation was defined as an increase in heart rate by more than five
beats per minute after injection of tyramine into the artery supplying the
SN. LV reinnervation was defined as a measurable LV NE release after left
main coronary injection of 8 micrograms/kg tyramine. In 13 patients with
previously known LV reinnervation, regional LV reinnervation was assessed
by NE release after subselective injection of tyramine (4 micrograms/kg)
into the proximal left anterior descending and circumflex arteries. Five of
five patients < or = 4 months after cardiac transplantation had no
change in heart rate and no LV NE release, confirming early, total
denervation. In contrast, > or = 1 year after cardiac transplantation,
tyramine caused a heart rate increase (eight to 49 beats per minute) in 32
of 45 patients and LV NE release in 33 of 45. Although LV NE release was
correlated with the change in heart rate in late cardiac transplantation
recipients (r = .61), eight of 45 had only heart rate response, nine had
only LV NE release, and four had neither. In late cardiac transplantation
recipients with LV reinnervation, tyramine caused NE release from both the
anterior descending and circumflex perfusion fields in 10 of 14, but one of
14 patients released NE only after circumflex tyramine and three of 14 only
after left anterior descending tyramine stimulation. Tyramine caused a
marked heart rate increase and LV NE release in all control patients.
CONCLUSIONS. Sympathetic reinnervation after cardiac transplantation is
regionally heterogeneous. SN reinnervation is not associated necessarily
with LV reinnervation, and LV reinnervation can involve the anterior and
posterior walls together or separately.
ARTICLES
Regional differences in sympathetic reinnervation after human orthotopic cardiac transplantation
Department of Medicine, University of Minnesota, Minneapolis.
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