Background: Late after cardiac transplantation, limited reinnervation of th
e transplanted heart may occur, but little is known about the effect of rei
nnervation on cardiac function and exercise performance.
Methods: We quantified the extent of myocardial reinnervation noninvasively
in 29 cardiac-transplant recipients, using positron-emission tomography an
d the catecholamine analogue [C-11]hydroxyephedrine. Global and regional ve
ntricular function at rest and during standardized exercise testing was mea
sured with the use of radionuclide angiography, and the results were compar
ed with those in 10 healthy controls.
Results: Sympathetic reinnervation, mainly in the anteroseptal wall, was pr
esent in 16 of the 29 transplant recipients. At rest, hemodynamic differenc
es 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 enhanced in
transplant recipients with reinnervation and similar to that of normal con
trols. In a multivariate analysis, hydroxyephedrine retention was the only
independent determinant of the exercise-induced increase in the ejection fr
action.
Conclusions: In heart-transplant recipients, the restoration of sympathetic
innervation is associated with improved responses of the heart rate and co
ntractile function to exercise. These results support the functional import
ance of reinnervation in transplanted hearts.