Cardiac natriuretic peptides during exercise and training after heart transplantation

Early Denervation and Later Reinnervation of the Heart Following Cardiac Transplantation: A Review

“…Therefore, cardiac denervation alters cardiovascular control in HTx recipients . It results in lower cardiac index (CI) and heart rate variability (HRV) or heart period variability (HPV), abnormal chronotropic response to exercise, abnormal catecholamine release and hemodynamic responses to exercise and tyramine injection, impaired exercise capacity and physical function, altered diastolic function of the ventricles, presynaptic inotropic supersensitivity and lower inotropic reserve, higher resting HR due to the lack of parasympathetic vagal efferent nerve connections, higher stroke volume (SV), temporary sinus node dysfunction, abnormal cardiopulmonary baroreflexes, depletion of cardiac norepinephrine (NE) within the nerve terminals, higher sensitivity to circulating endogenous CAT due to the lack of presynaptic neuronal uptake capacity which may increase the frequency of arrhythmias, and altered response to adrenergic drugs, which requires adjustments to pharmacotherapy in HTx recipients …”

“…Cardiac denervation, however, appears not to affect the cardiac production of atrial natriuretic peptide (ANP) and the intrinsic nerve supply in the heart . This may be due to cardiac denervation indirectly causing ANP release during exercise by adjusting atrial stretch and increasing the need for elevated CAT and arginine vasopressin (AVP) .…”

Time‐Dependent Changes in B‐Type Natriuretic Peptide After Heart Transplantation: Correlation With Allograft Rejection and Function

“…Also less well established is the association with cardiac function in this patient population. 3,[5][6][7] High endothelin levels after cardiac transplantation, through renal or hypertensive effects, may also contribute to the increase in cardiac natriuretic peptides in general. [1][2][3] One study has shown that BNP levels increase with time after transplant, possibly as a compensatory mechanism to improve ventricular function, although no significant relationship with intracardiac pressure was found.…”

“…Earlier studies have shown that plasma BNP levels remain high after cardiac transplantation. 3,5 In order to closely evaluate the significance of BNP plasma level variability in cardiac transplant recipients, we conducted this prospective study to correlate findings on endomyocardial biopsies (EMBs) with plasma BNP levels measured at the time of the biopsy. 4 Multiple factors likely contribute to this rise in BNP levels: abnormal renal function, the diastolic dysfunction seen after cardiac transplantation, especially in the early post-operative period, and preexisting vascular dysfunction.…”

Reabilitação física no transplante de coração

“…Transplanted individuals submitted to cardiac rehabilitation programs in exercise sessions of four times a week with moderate intensity present improvement in the aerobic capacity between 20 and 50%. The possible mechanisms for this improvement are the increase in the peripheral metabolism, especially through the better oxygen extraction and hemodynamic changes including the increase in the heart rate, the cardiac output (20) , the endothelial function (16) and the reduction in the neurohormonal activity (21) . Besides, the respiratory efficiency is also improved during exercise (15) .…”