Sympathetic reinnervation after heart transplantation, assessed by iodine-123 metaiodobenzylguanidine imaging, and heart rate variability

Lovric, Silvia Samarin; Avbelj, Viktor; Trobec, Roman; Zorman, Darko; Rakovec, Peter; Hojker, Sergej; Geršak, Borut; Milčinski, Metka

doi:10.1016/j.ejcts.2004.07.025

Cited by 40 publications

(39 citation statements)

References 18 publications

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“…However, cardiac reinnervation is a rather slow and variable process [9,10,26,27,28], and partial autonomic reinnervation occurs 3 years after transplantation [29,30,31,32,33,34,35]. In some studies, a nonsignificant higher peak heart rate was noted in the subjects of exercise groups after training [2,20,24].…”

Section: Discussionmentioning

confidence: 99%

Effects of Exercise Training in Heart Transplant Recipients: A Meta-Analysis

Hsieh

Chao

2011

Cardiology

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Objectives: Muscle wasting and exercise intolerance are common in heart transplant recipients. Most studies on the effects of exercise training have used relatively small sample sizes and are heterogeneous in nature. The purpose of this meta-analysis was to systematically review the relevant studies and investigate the effects of exercise training on exercise capacity and muscle strength in heart transplant recipients. Methods: A systematic search was adopted from electronic databases and relevant references, using medical subject heading key words related to heart transplantation and exercise. Only randomized controlled trials with exercise intervention versus usual care were included. The data were expressed as the weighted mean differences with 95% confidence intervals (CIs). Results: Altogether 6 studies were included. Peak oxygen consumption (VO₂) was reported in 4 trials (117 patients), and muscle strength was reported in 3 trials (67 patients). Peak VO₂ was significantly increased by 2.34 ml/kg/min (95% CI 0.63–4.05). One-repetition maxima of the chest press (23.28 kg, 95% CI 0.64–45.91) and leg press (28.84 kg, 95% CI 5.70–51.98) were significantly improved by exercise training. Conclusion: Exercise training is recommended for heart transplant recipients to improve peak VO₂ and muscle strength despite the small number of trials included in this meta-analysis.

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Section: Discussionmentioning

confidence: 99%

Effects of Exercise Training in Heart Transplant Recipients: A Meta-Analysis

Hsieh

Chao

2011

Cardiology

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“…3,[7][8][9][10][11][12] However, most studies were executed by cross-sectional observation at several years after HTx, while fewer studies were conducted successively within postoperative 1 year. Moreover, little has been investigated about parasympathetic reinnervation.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6] Recent clinical and experimental studies have provided evidence of progressive partial sympathetic reinnervation during several years after HTx through HR variability (HRV) analyses, positron emission tomography imaging with the catecholamine analogue C-11 hydroxyephedrine, or hormonal measurement. 3,[7][8][9][10][11][12] However, most studies were executed by cross-sectional observation at several years after HTx, while fewer studies were conducted successively within postoperative 1 year. Moreover, little has been investigated about parasympathetic reinnervation.…”

Section: H Eart Transplantation (Htx) Is the Ultimate Treatment Formentioning

confidence: 99%

Recipients With Shorter Cardiopulmonary Bypass Time Achieve Improvement of Parasympathetic Reinnervation Within 6 Months After Heart Transplantation

et al. 2014

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SummaryAlthough cross-sectional late-phase reinnervation in heart transplantation (HTx) recipients has been demonstrated by several earlier studies, early-phase successive analyses especially for parasympathetic reinnervation remain unknown. Successive heart rate variability (HRV) data calculated by the MemCalc power spectral density method were obtained from 16 non-rejection recipients 1-24 weeks after HTx. High frequency (HF) level representing parasympathetic magnitude increased significantly at 6 months after HTx (from 0.9 ± 0.7 to 4.1 ± 2.8 ms Key words: Sympathetic, Heart rate variability, Memcalc, Donor H eart transplantation (HTx) is the ultimate treatment for patients with stage D heart failure because the deteriorated heart of the recipient is completely replaced with a healthy donor heart. However, complete allograft denervation occurs during the operation, 1) which results in adverse clinical effects including higher heart rates (HR) at rest, slow acceleration of HR during exercise, decreased exercise tolerability, and absence of angina at coronary ischemia.2-6) Recent clinical and experimental studies have provided evidence of progressive partial sympathetic reinnervation during several years after HTx through HR variability (HRV) analyses, positron emission tomography imaging with the catecholamine analogue C-11 hydroxyephedrine, or hormonal measurement. 3,[7][8][9][10][11][12] However, most studies were executed by cross-sectional observation at several years after HTx, while fewer studies were conducted successively within postoperative 1 year. Moreover, little has been investigated about parasympathetic reinnervation. We here analyzed successive HRV parameters 1-24 weeks after HTx to investigate postoperative early-stage parasympathetic reinnervation.

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“…Cardiac 123 I-MIBG imaging may be also useful for the assessment of reinnervation in transplanted hearts. Cardiac neuroimaging with 11 C-metahydroxyephedrine or 123 I-MIBG identifies ventricular sympathetic reinnervation (70)(71)(72), which slowly develops from the cardiac base several months after surgery and is observed in 40% of heart transplant patients 1 y after surgery (73). Although the clinical implications and mechanisms of the cardiac reinnervation process are not necessarily revealed, the restoration of cardiac sympathetic innervation is likely to increase exercise capacity by improving the blunted physiologic responses of heart rate and contractile function to exercise in patients with heart transplants (73).…”

Section: Cardiac 123 I-mibg Imaging In Heart Transplantationmentioning

confidence: 99%

Cardiac ¹²³I-MIBG Imaging for Clinical Decision Making: 22-Year Experience in Japan

Nakajima

Nakata

2015

J Nucl Med

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Cardiac neuroimaging with 123 I-metaiodobenzylguanidine ( 123 I-MIBG) has been officially used in clinical practice in Japan since 1992. The nuclear cardiology guidelines of the Japanese Circulation Society, revised in 2010, recommended cardiac 123 I-MIBG imaging for the management of heart failure (HF) patients, particularly for the assessment of HF severity and prognosis of HF patients. Consensus in North American and European countries regarding incorporation into clinical practice, however, has not been established yet. This article summarizes 22 y of clinical applications in Japan of 123 I-MIBG imaging in the field of cardiology; these applications are reflected in cardiology guidelines, including recent methodologic advances. A standardized cardiac 123 I-MIBG parameter, the heartto-mediastinum ratio (HMR), is the basis for clinical decision making and enables common use of parameters beyond differences in institutions and studies. Several clinical studies unanimously demonstrated its potent independent roles in prognosis evaluation and risk stratification irrespective of HF etiologies. An HMR of less than 1.6−1.8 and an accelerated washout rate are recognized as high-risk indicators of pump failure death, sudden cardiac death, and fatal arrhythmias and have independent and incremental prognostic values together with known clinical variables, such as left ventricular ejection fraction and brain natriuretic peptide. Another possible use of this imaging technique is the selection of therapeutic strategy, such as pharmacologic treatment and nonpharmacologic treatment with an implantable cardioverter-defibrillator or cardiac resynchronization device; however, this possibility remains to be investigated. Recent multiple-cohort database analyses definitively demonstrated that patients who were at low risk for lethal events and who were defined by an HMR of greater than 2.0 on 123 I-MIBG studies had a good long-term prognosis. Future investigations of cardiac 123 I-MIBG imaging will contribute to better risk stratification of low-risk and high-risk populations, to the establishment of costeffective use of this imaging technique for the management of HF patients, and to worldwide acceptance of this imaging technique in clinical cardiology practice.

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Sympathetic reinnervation after heart transplantation, assessed by iodine-123 metaiodobenzylguanidine imaging, and heart rate variability

Cited by 40 publications

References 18 publications

Effects of Exercise Training in Heart Transplant Recipients: A Meta-Analysis

Effects of Exercise Training in Heart Transplant Recipients: A Meta-Analysis

Recipients With Shorter Cardiopulmonary Bypass Time Achieve Improvement of Parasympathetic Reinnervation Within 6 Months After Heart Transplantation

Cardiac ¹²³I-MIBG Imaging for Clinical Decision Making: 22-Year Experience in Japan

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Sympathetic reinnervation after heart transplantation, assessed by iodine-123 metaiodobenzylguanidine imaging, and heart rate variability

Cited by 40 publications

References 18 publications

Effects of Exercise Training in Heart Transplant Recipients: A Meta-Analysis

Effects of Exercise Training in Heart Transplant Recipients: A Meta-Analysis

Recipients With Shorter Cardiopulmonary Bypass Time Achieve Improvement of Parasympathetic Reinnervation Within 6 Months After Heart Transplantation

Cardiac 123I-MIBG Imaging for Clinical Decision Making: 22-Year Experience in Japan

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Cardiac ¹²³I-MIBG Imaging for Clinical Decision Making: 22-Year Experience in Japan