Haywood G A, Counihan P J, Sneddon J F, Jennison S H, Bashir Y, McKenna W J
St George's Hospital, London.
Br Heart J. 1993 Sep;70(3):247-51. doi: 10.1136/hrt.70.3.247.
To test the hypothesis that the loss of the inhibitory effect of the cardiac ventricular afferent fibres on the vasomotor centre would result in increased vasoconstrictor drive to the forearm and renal vascular beds during supine exercise in heart transplant recipients.
Comparison of regional haemodynamic response to exercise in heart transplant recipients and two age matched control groups.
Regional heart transplant unit.
Orthotopic heart transplant recipients (n = 10), patients with NYHA class II heart failure (n = 10), and normal controls (n = 10) underwent short duration maximal supine bicycle exercise.
Simultaneous measurements were made of heart rate, systemic blood pressure, oxygen consumption (VO2), forearm blood flow, and renal blood flow. Forearm blood flow was measured by forearm plethysmography and renal blood flow by continuous renal vein thermodilution.
The peak forearm vascular resistance was significantly greater in the transplant group than in the controls (mean (SEM) 75 (18) v 40 (7) resistance units, p < 0.05). The percentage fall in renal blood flow at peak exercise was significantly greater in heart transplant recipients than in the controls (44% (4%) v 32% (4%), p < 0.05) as was the percentage increase in renal vascular resistance (transplants: 116% (19%) v controls: 78% (17%), p < 0.05). Regional haemodynamics during exercise in the heart failure group were not significantly different from those in the controls.
These findings suggest that surgical division of the cardiac ventricular afferent fibres results in increased vasoconstrictor drive to the kidneys and non-exercising muscle during exercise. This mechanism may contribute to persistent exercise limitation and renal impairment after heart transplantation.
验证以下假说：心脏心室传入纤维对血管运动中枢的抑制作用丧失，会导致心脏移植受者在仰卧位运动时，前臂和肾血管床的血管收缩驱动力增加。
比较心脏移植受者与两个年龄匹配的对照组运动时的局部血流动力学反应。
地区性心脏移植中心。
原位心脏移植受者（n = 10）、纽约心脏协会（NYHA）II级心力衰竭患者（n = 10）和正常对照组（n = 10）进行短时间最大强度仰卧位自行车运动。
同时测量心率、全身血压、耗氧量（VO₂）、前臂血流量和肾血流量。前臂血流量通过前臂体积描记法测量，肾血流量通过连续肾静脉热稀释法测量。
移植组的峰值前臂血管阻力显著高于对照组（均值（标准误）75（18）对40（7）阻力单位，p < 0.05）。心脏移植受者运动峰值时肾血流量的下降百分比显著大于对照组（44%（4%）对32%（4%），p < 0.05），肾血管阻力的增加百分比也是如此（移植组：116%（19%）对对照组：78%（17%），p < 0.05）。心力衰竭组运动时的局部血流动力学与对照组无显著差异。
这些发现表明，心脏心室传入纤维的手术切断导致运动时肾脏和非运动肌肉的血管收缩驱动力增加。这种机制可能导致心脏移植后持续的运动受限和肾功能损害。
