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European Heart Journal 1993 14(4):474-483;
Copyright © 1993 by the European Society of Cardiology.
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© 1993 The European Society of Cardiology

Effects of adrenaline on ventricular function and coronary haemodynamics in relation to catecholamine handling in transplanted human hearts

J. ROCA, M.CRUZ CATURLA, P. HJEMDAHL*, M. MASOTTI, A. VENTURA, A. ORIOL and C. CREXELLS

Cardiac Catheterization Unit, Hospital de la Santa Creu i Sant Pau Barcelona, Spain
*Departments of Clinical Pharmacology, Karolinska Hospital, and Pharmacology, Karolinska institute Stockholm, Sweden

Received 14 February 1992; revised 18 September 1992; .

Correspondence: C Crexells MD, FESC, Cardiac Catheterization Unit, Hospital General de Catalunya, 08190 Sant Cugat del Vallés, Barcelona, Spain.

Abstract

We investigated cardiovascular and coronary responses to intravenous infusions of adrenaline, which raised arterial concentrations in a stepwise fashion from basal to about 5–6 nmol. l–1, in 11 non-rejecting heart transplanted patients, and in eight intact innervated subjects. Cardiac adrenaline extraction and noradrenaline release rate were also measured.

The transplanted patients showed larger increases in heart rate (36±11% vs 16±6%, P<0.0001 and cardiac index (80±30% vs 56±19%, P<0.05), while stroke volume increments were similar in the two groups (32±17% vs 35±13%). The study groups did not differ with respect to changes in arterial pressure, cardiac work or peripheral resistances. Coronary sinus blood flow increased to a greater extent in the transplanted group (75±35% vs 48±31%, P <0.05) and myocardial oxygen consumption also tended to increase more in these patients (78±42% vs 48±34%, NS). Myocardial adrenaline extraction was greatly reduced in the transplant patients (–6±25% vs 64±18%, P<0.001), while forearm adrenaline extraction was similar in the two groups (41±22% vs 40±23%, NS). Cardiac noradrenaline overflow tended to be lower in the transplanted group (12±62 vs 48±43 pmol. min–1, NS). There was a wide range of noradrenaline overflow values (–64 to 147 pmol. min–1) and definite high values in three patients. Cardiac noradrenaline overflow was not correlated to heart rate responsiveness to adrenaline.

We conclude that patients with cardiac transplantation respond to adrenaline with exaggerated increases in heart rate and thus in cardiac output. High values of cardiac noradrenaline overflow are seen in some transplant recipients and may suggest reinnervation. Signs of reinnervation are not associated with consistently lower heart rate responses to ß-adrenergic stimulation.

Key Words: Heart transplant, catecholamines • cardiac reinnervation • cardiac noradrenaline overflow • adrenergic supersensitivity • denervated heart


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