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European Heart Journal 2004 25(19):1726-1733; doi:10.1016/j.ehj.2004.07.009
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

Sympathetic reinnervation, exercise performance and effects of ß-adrenergic blockade in cardiac transplant recipients

Frank M. Bengela,*, Peter Ueberfuhrb, Jessica Karjaa, Karin Schreibera, Stephan G. Nekollaa, Bruno Reichartb and Markus Schwaigera

a Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München, Klinikum rechts der Isar, Ismaninger Str. 22, München 81675, Germany
b Herzchirurgische Klinik der Ludwig-Maximilians Universität München, Munich, Germany

Received March 21, 2004; revised June 24, 2004; accepted July 1, 2004 * Corresponding author. Tel.: +49 89 4140 2971; fax: +49 89 4140 4950 (E-mail: frank.bengel{at}lrz.tu-muenchen.de).

AIMS: To evaluate effects of ß-adrenergic receptor blockade on allograft performance, and to correlate these effects with sympathetic reinnervation.

METHODS AND RESULTS: Myocardial catecholamine storage capacity was determined in 12 non-rejecting transplant recipients using PET and C-11 adrenaline (epinephrine). Haemodynamics and left ventricular function were measured using radionuclide angiography at rest and during symptom-limited exercise before and after non-selective ß-blockade (propranolol iv). Exercise time and stress-induced increases of heart rate and LVEF before ß-blockade were significantly higher in reinnervated compared to denervated recipients. While resting LVEF remained unchanged, heart rate and blood pressure were generally reduced by ß-blockade, which was well tolerated by all patients. Exercise time and increases of heart rate and LVEF were more attenuated in reinnervated recipients. Differences of chronotropic and inotropic response to exercise between groups were no longer present following ß-blockade. Correlations between myocardial adrenaline retention, peak heart rate and increase of global, as well as regional ejection fraction during exercise were observed before, but not during ß-blockade.

CONCLUSION: Acute, non-selective ß-blockade is well tolerated by transplant recipients, but significantly attenuates beneficial functional effects of sympathetic reinnervation on exercise performance. The data suggest that reappearance of sympathetic nerve terminals is associated with reestablishment of intact pre-/postsynaptic interaction.


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