Myocardial efficiency and sympathetic reinnervation after orthotopic heart transplantation: A noninvasive study with positron emission tomography

Frank M. Bengel, Peter Ueberfuhr, Nina Schiepel, Stephan G. Nekolla, Bruno Reichart, Markus Schwaiger

Research output: Contribution to journalArticle

Abstract

Background - The lack of cardiac catecholamine uptake and storage caused by sympathetic denervation may influence performance of the transplanted heart. Reinnervation, occurring late after transplantation, may partially resolve these effects. In this study, oxidative metabolism and its relation to cardiac work were compared in allografts and normal and failing hearts, and the effects of sympathetic reinnervation were evaluated. Methods and Results - Twenty-seven nonrejecting, symptom-free transplant recipients, 11 healthy control subjects, and 10 patients with severe dilated cardiomyopathy underwent PET with 11C acetate for assessment of oxidative metabolism by the clearance constant k(mono) and radionuclide angiography or MRI for measurement of ventricular function, geometry, and work. Efficiency was estimated noninvasively by a work-metabolic index [WMI=(stroke volume×heart rate×systolic pressure)/k(mono)]. In 14 of 27 transplants, presence of regional reinnervation was identified with PET and the catecholamine analogue 11C hydroxyephedrine (extent, 24±14% of left ventricle). The WMI was comparable in normal subjects and reinnervated and denervated transplants (6.2±2.3 versus 4.9±2.0 versus 4.9±1.2 · 106 mm Hg · mL; P=NS) and significantly lower in cardiomyopathy patients (3.0±1.3 · 106 mm Hg · mL; P<0.001). For normal subjects and transplant recipients, the WMI was significantly correlated with afterload (peripheral vascular resistance; r=-0.65, P<0.01), preload (end-diastolic volume; r=0.78, P<0.01), and stroke volume (r=0.81, P<0.01) but not with hydroxyephedrine retention (transplants only; r=0.09, P=NS). Conclusions - After transplantation, cardiac efficiency is improved compared with failing hearts and comparable to normal hearts. Differences between denervated and reinnervated allografts were not surveyed. Additionally, the dependency on loading conditions and contractility was preserved, suggesting that normal regulatory interactions for efficiency are intact and that sympathetic tone does not play a role under resting conditions.

Original languageEnglish (US)
Pages (from-to)1881-1886
Number of pages6
JournalCirculation
Volume103
Issue number14
DOIs
StatePublished - Apr 10 2001

Keywords

  • Myocardium
  • Nervous system, sympathetic
  • Tomography
  • Transplantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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