(Circulation. 1995;92:2895-2903.)
© 1995 American Heart Association, Inc.
Articles |
Demonstrable Cardiac Reinnervation After Human Heart Transplantation by Carotid Baroreflex Modulation of RR Interval
Presented in part at the 67th Scientific Sessions of the American Heart Association, Dallas, Tex, November 14-17, 1994, and the 55th Congress of the Italian Society of Cardiology, Rome, Italy, December 13-16, 1994, and published in abstract form (Circulation. 1994;90[pt 2]:I-540).
From the Dipartimento di Medicina Interna and Cattedra di Cardiochirurgia (M.V., M.R., L.M.), IRCCS S. Matteo and University of Pavia, Italy, and the Department of Cardiovascular Medicine (P.S.), John Radcliffe Hospital, Oxford, England.
Correspondence to Dr Luciano Bernardi, Clinica Medica 1, Universitá di Pavia, 27100 Pavia, Italy.
Background After heart transplantation, respiration-synchronous fluctuations (0.18 to 0.35 Hz, high frequency [HF]) in RR interval may result from atrial stretch caused by changes in venous return, but slower fluctuations (0.03 to 0.15 Hz, low frequency [LF]) not due to respiration suggest reinnervation. In normal subjects, sinusoidal neck suction selectively stimulates carotid baroreceptors and causes reflex oscillations of RR interval.
Methods and Results To evaluate the presence of reinnervation, we measured the power of RR-LF and RR-HF in 26 heart transplant recipients and 16 control subjects before and during sinusoidal neck suction at 0.1 Hz and 0.20 Hz (similar to but distinct from that of controlled respiration, 0.25 Hz) and before and during administration of atropine or ß-blocker (esmolol hydrochloride) by spectral analysis. All transplant recipients showed small respiratory HF fluctuations. Nonrespiratory LF fluctuations were present in 13 of 26 transplant recipients and increased with months since transplantation (r=.53, P<.01). HF neck suction induced a 0.20-Hz component in all 16 control subjects and none of the 26 transplant subjects. LF neck suction increased RR-LF (from 0.73±0.20 to 1.30±0.26 ln ms2, P<.001), similar to but less than in control subjects (from 6.12±0.21 to 8.27±0.21 ln ms2, P<.001). Atropine reduced all fluctuations in control subjects and blocked the HF increase caused by 0.20-Hz neck suction but not the LF increase during 0.10-Hz stimulation. Neck suction–induced changes in LF fluctuations persisted after administration of atropine in transplant recipients but were attenuated by esmolol hydrochloride, suggesting sympathetic rather than vagal reinnervation.
Conclusions The presence of baroreceptor-induced RR oscillations is evidence of functional, although incomplete, autonomic reinnervation.
Key Words: heart rate • nervous system • autonomic • transplantation • baroreceptors • reflex
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