Bengel F M, Ueberfuhr P, Schiepel N, Nekolla S G, Reichart B, Schwaiger M
Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München, Klinikum rechts der Isar, Germany.
N Engl J Med. 2001 Sep 6;345(10):731-8. doi: 10.1056/NEJMoa010519.
Late after cardiac transplantation, limited reinnervation of the transplanted heart may occur, but little is known about the effect of reinnervation on cardiac function and exercise performance.
We quantified the extent of myocardial reinnervation noninvasively in 29 cardiac-transplant recipients, using positron-emission tomography and the catecholamine analogue [11C]hydroxyephedrine. Global and regional ventricular function at rest and during standardized exercise testing were measured with the use of radionuclide angiography, and the results were compared with those in 10 healthy controls.
Sympathetic reinnervation, mainly in the anteroseptal wall, was present in 16 of the 29 transplant recipients. At rest, hemodynamic differences were not observed between the patients with reinnervation and those with denervation. However, the latter group had a shorter mean (+/-SD) exercise time (6.1+/-1.5, minutes vs. 8.2+/-1.2 in the group with reinnervation; P<0.01) and a lower peak heart rate (121+/-13 vs. 143+/-15 beats per minute, P<0.01). The contractile response to exercise was significantly enchanced in transplant recipients with reinnervation and similar to that of normal controls. In a multivariate analysis, hydroxyephedrine retention was the only independent determinant of the exercise-induced increase in the ejection fraction.
In heart-transplant recipients, the restoration of sympathetic innervation is associated with improved responses of the heart rate and contractile function to exercise. These results support the functional importance of reinnervation in transplanted hearts.
心脏移植术后晚期，移植心脏可能会出现有限的神经再生，但关于神经再生对心脏功能和运动能力的影响知之甚少。
我们使用正电子发射断层扫描和儿茶酚胺类似物[11C]羟基麻黄碱，对29名心脏移植受者的心肌神经再生程度进行了无创量化。使用放射性核素血管造影测量静息和标准化运动测试期间的整体和局部心室功能，并将结果与10名健康对照者进行比较。
29名移植受者中有16名存在交感神经再生，主要位于前间隔壁。静息时，神经再生患者和去神经患者之间未观察到血流动力学差异。然而，后一组的平均（±标准差）运动时间较短（6.1±1.5分钟，而神经再生组为8.2±1.2分钟；P<0.01），峰值心率较低（121±13次/分钟对143±15次/分钟，P<0.01）。神经再生的移植受者对运动的收缩反应明显增强，与正常对照组相似。在多变量分析中，羟基麻黄碱潴留是运动诱导射血分数增加的唯一独立决定因素。
在心脏移植受者中，交感神经支配的恢复与心率和收缩功能对运动的反应改善有关。这些结果支持了神经再生在移植心脏中的功能重要性。
