Christensen Anders H, Wyller Vegard B B, Nygaard Sissel, Rolid Katrine, Nytrøen Kari, Gullestad Lars, Fiane Arnt, Thaulow Erik, Saul J Philip, Døhlen Gaute
Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Faculty of Medicine, University of Oslo, Oslo, Norway.
Transplant Direct. 2023 Nov 2;9(12):e1553. doi: 10.1097/TXD.0000000000001553. eCollection 2023 Dec.
Factors associated with sympathetic and parasympathetic sinoatrial reinnervation after heart transplantation (HTx) are inadequately studied.
Fifty transplant recipients were examined at 7 to 12 wk (index visit), 6, 12, 24, and 36 mo after HTx. Supine rest heart rate variability in the low-frequency (LF) domain (sympathetic and parasympathetic sinoatrial reinnervation) and the high-frequency (HF) domain (parasympathetic sinoatrial reinnervation) were measured repeatedly and related to selected recipient, donor, and perisurgical characteristics. We primarily aimed to identify index visit factors that affect the sinoatrial reinnervation process. Secondarily, we examined overall associations between indices of reinnervation and repeatedly measured recipient characteristics to generate new hypotheses regarding the consequences of reinnervation.
LF and HF variability increased time dependently. In multivariate modeling, a pretransplant diagnosis of nonischemic cardiomyopathy ( = 0.038) and higher index visit handgrip strength ( = 0.028) predicted improved LF variability. Recipient age, early episodes of rejection, and duration of extracorporeal circulation were not associated with indices of reinnervation. Study average handgrip strength was positively associated with LF and HF variability (respectively, = 0.005 and = 0.029), whereas study average C-reactive protein was negatively associated (respectively, = 0.015 and = 0.008).
Indices of both sympathetic and parasympathetic sinoatrial reinnervation increased with time after HTx. A pretransplant diagnosis of nonischemic cardiomyopathy and higher index visit handgrip strength predicted higher indices of mainly sympathetic reinnervation, whereas age, rejection episodes, and duration of extracorporeal circulation had no association. HTx recipients with higher indices of reinnervation had higher average handgrip strength, suggesting a link between reinnervation and improved frailty. The more reinnervated participants had lower average C-reactive protein, suggesting an inhibitory effect of reinnervation on inflammation, possibly through enhanced function of the inflammatory reflex. These potential effects of reinnervation may affect long-term morbidity in HTx patients and should be scrutinized in future research.
心脏移植（HTx）后与交感和副交感窦房结再神经化相关的因素研究不足。
50名移植受者在HTx后7至12周（首次访视）、6、12、24和36个月接受检查。多次测量静息心率在低频（LF）域（交感和副交感窦房结再神经化）和高频（HF）域（副交感窦房结再神经化）的变异性，并将其与选定的受者、供者和围手术期特征相关联。我们主要旨在确定影响窦房结再神经化过程的首次访视因素。其次，我们检查了再神经化指标与多次测量的受者特征之间的总体关联，以产生关于再神经化后果的新假设。
LF和HF变异性随时间增加。在多变量建模中，移植前非缺血性心肌病的诊断（P = 0.038）和首次访视时较高的握力（P = 0.028）预示着LF变异性改善。受者年龄、早期排斥发作和体外循环持续时间与再神经化指标无关。研究平均握力与LF和HF变异性呈正相关（分别为P = 0.005和P = 0.029），而研究平均C反应蛋白呈负相关（分别为P = 0.015和P = 0.008）。
HTx后交感和副交感窦房结再神经化指标均随时间增加。移植前非缺血性心肌病的诊断和首次访视时较高的握力预示着主要交感再神经化指标较高，而年龄、排斥发作和体外循环持续时间无关。再神经化指标较高的HTx受者平均握力较高，提示再神经化与衰弱改善之间存在联系。再神经化程度较高的参与者平均C反应蛋白较低，提示再神经化可能通过增强炎症反射功能对炎症有抑制作用。再神经化的这些潜在影响可能会影响HTx患者的长期发病率，应在未来研究中进行仔细审查。
