Ramaekers D, Ector H, Vanhaecke J, van Cleemput J, van de Werf F
Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
Pacing Clin Electrophysiol. 1996 Dec;19(12 Pt 1):2112-9. doi: 10.1111/j.1540-8159.1996.tb03286.x.
The reappearance of cardiac innervation after cardiac transplantation remains a matter of debate. We evaluated the ability of heart rate variability (HRV) analysis to detect the extent and time course of functional cardiac allograft reinnervation. Time- and frequency-domain analysis of heart rate was performed on Holter recordings of 120 heart transplant and four heart-lung transplant recipients. A high frequency (HF) component was clearly distinguished on visual inspection of power spectral density in 42 patients. In eight patients an HF component of normal magnitude was detected. The other 34 patients in this group, including all four heart-lung transplants, presented with a very small HF component. The other 82 patients showed a flat spectrum. The group with an HF component of normal amplitude was significantly different, compared to the other groups, for all HRV parameters. Serial plotting of HRV parameters of the patients with an HF component of normal amplitude against time posttransplant, revealed, from 12 months onwards, a progressive increase of parameters denoting HF variability. In five heart transplant patients with acute allograft rejection, the use of HRV analysis for rejection monitoring was unsuccessful. These results suggest that, inasmuch as the HF component of HRV is caused by parasympathetic cardiac innervation, the HF component of normal amplitude, observed in only a minority of cardiac transplant recipients (6%), is a marker for parasympathetic reinnervation. The evolution over time of this HF component is compatible with a biological phenomenon as gradual parasympathetic reinnervation of the sinus node.
心脏移植后心脏神经支配的重新出现仍是一个有争议的问题。我们评估了心率变异性（HRV）分析检测心脏同种异体移植功能再神经支配程度和时间进程的能力。对120名心脏移植受者和4名心肺移植受者的动态心电图记录进行心率的时域和频域分析。在42例患者的功率谱密度视觉检查中可清晰分辨出高频（HF）成分。在8例患者中检测到正常幅度的HF成分。该组中的其他34例患者，包括所有4例心肺移植受者，呈现出非常小的HF成分。其他82例患者显示频谱平坦。与其他组相比，具有正常幅度HF成分的组在所有HRV参数方面均有显著差异。对具有正常幅度HF成分的患者的HRV参数随移植后时间进行系列绘图，结果显示，从12个月起，表示HF变异性的参数逐渐增加。在5例发生急性移植排斥反应的心脏移植患者中，使用HRV分析进行排斥反应监测未成功。这些结果表明，鉴于HRV的HF成分是由心脏副交感神经支配引起的，仅在少数心脏移植受者（6%）中观察到的正常幅度HF成分是副交感神经再神经支配的一个标志。该HF成分随时间的演变与窦房结副交感神经逐渐再神经支配这一生物学现象相符。
