Sympathetic reinnervation of sinus node and left ventricle after heart transplantation in humans:: Regional differences assessed by heart rate variability and positron emission tomography
Sympathetic reinnervation of sinus node and left ventricle after heart transplantation in humans:: Regional differences assessed by heart rate variability and positron emission tomography
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DOI：
10.1016/s1053-2498(00)00060-7
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发表时间：
2000-04-01
影响因子：
8.9
通讯作者：
Schwaiger, M
中科院分区：
文献类型：
--
作者：
Überfuhr, P;Frey, AW;Schwaiger, M
背景：原位心脏移植(HTX)导致心脏完全失神经。HTX术后数年患者部分交感神经功能已重建。方法：采用两种平行的方法评价交感神经在心肌中的区域恢复情况。应用正电子发射断层扫描(PET)和去甲肾上腺素类似物羟基麻黄碱(HED)对患者进行了脑室神经再支配(VI)的研究。示踪剂摄取使用动态成像方案进行量化，得到区域HED保留分数。局部值高于7%/分钟(高于失神经心脏平均值的+/-2.5SD)被认为是交感神经再支配的证据。心率变异性(HRV)频谱分析可作为窦房结(SI)神经再支配的定量指标。计算正直立倾斜时的心率变异性频谱。结果：HTX后(4.6+/-3.9岁，0.2~13.6岁)，38例患者(年龄50.9+/-7.6岁，37~65岁)接受了正电子发射计算机断层扫描和心率变异性检查。22例HED平均保留10.7+/-2.6%/分钟的患者被归类为左心室再支配。16例HED平均滞留率为4.8+/-0.8%/分钟的患者未达到阈值。两组患者HTX后的时间差异显著，5.3+/-3.0年vs3.8+/-4.7年(p<；0.05)。心室再支配患者的低频功率谱密度分别为5.9±8.6ms(2)和1.8+/-4.4ms(2)(P
Background: Orthotopic heart transplantation (HTx) results in complete cardiac denervation. Reestablished partial sympathetic nerve function has been found in patients some years after HTx. However, the atrial and ventricular regional patterns of reinnervation have not been established.Methods: Two parallel methods were used to evaluate the regional restoration of sympathetic nerves in the myocardium. Patients were investigated with respect to ventricular reinnervation (VI) using positron emission tomography (PET) and the norepinephrine analogue C-ll-hydroxyephedrine (HED). Tracer uptake was quantified using dynamic imaging protocols, yielding regional HED retention fraction. A regional value above 7%/minute (+/- 2.5 SD above the mean value of denervated hearts) was considered evidence of sympathetic reinnervation. Spectral analysis of heart rate variability (HRV) served as a quantitative marker for reinnervation at the sinus node (SI). Spectra of HRV during positive head-up tilt were calculated. The low frequency (LF) power spectral density (0.05 to 0.18 Hz) was evaluated.Results: after HTx (4.6 +/- 3.9 years; range, 0.2 to 13.6 years), 38 patients (aged 50.9 +/- 7.6 years; range, 37 to 65 years) were investigated by PET imaging and HRV. Twenty-two patients with a mean HED retention of 10.7 +/- 2.6%/minute were classified as left ventricular reinnervated. Sixteen patients with a mean HED retention of 4.8 +/- 0.8%/minute did not reach the threshold. The time difference after HTx was significant for these 2 groups, 5.3 +/- 3.0 years vs 3.8 +/- 4.7 years (p < 0.05). The LF power spectral density of the ventricular reinnervated patients was 5.9 +/- 8.6 ms(2), and 1.8 +/- 4.4 ms(2) (p