Serial evaluation of left ventricular function by radionuclide ventriculography at rest and during exercise after orthotopic heart transplantation

Abstract

Discrepant results have previously been reported concerning long-term left ventricular function in the human transplanted heart as assessed by radionuclide ventriculography. In this study, radionuclide ventriculograms were obtained at rest and during exercise in 19 patients < 6 months, 7-12 months, 13-24 months and > 24 months after transplantation. Ejection fraction decreased significantly from < 6 months to 13-24 months after transplantation (rest: 69.1% +/- 9.7% to 56.7% +/- 8.3%, P < 0.05; exercise: 70.4% +/- 11.3% to 59% +/- 8%, P < 0.05). Heart rate increased significantly during exercise after > 2 years (90.2 +/- 10.5 beats/min to 103.5 +/- 15 beats/min, P < 0.05) but not within 6 months after transplantation (98.5 +/- 12.8 beats/min to 99.07 +/- 15.8 beats/min). Left ventricular end-diastolic volume remained unchanged. Peak filling rate at rest decreased significantly from 4.2 +/- 0.96 edv/s < 6 months after transplantation to 3.3 +/- 0.66 edv/s (P < 0.05) 13-24 months and 3.3 +/- 0.64 edv/s (P < 0.05) > 24 months after cardiac transplantation. Exercise peak filing rate did not change significantly. It is concluded that radionuclide ventriculography demonstrates a decrease in systolic left ventricular function in the long-term course after cardiac transplantation. A significant increase in exercise peak heart rate may be due to autonomic reinnervation. Differences in the literature concerning left ventricular function may be due to different observation intervals following cardiac transplantation.

Decrease in heart ventricular ejection fraction during multiple sclerosis

“…Human transplanted heart provides a good example of cardiac autonomic dysfunction. Some authors have found a significant decrease in left VEF in patients as compared with healthy control subjects (Verani et al ., 1994) or during the long‐term course after heart transplantation (Hartmann et al ., 1993) (<6 months and >24 months). As in human transplanted heart, impairment of cardiovascular autonomic function may account for VEF decrease at rest in MS patients.…”

Sympathische Reinnervation nach Herztransplantation -Doppelnuklidstudie mit 123J-MIBG und 201Tl

“…Die notwendige Erhöhung der linksventrikulären Auswurfleistung erfolgt daher über eine Z u n a h m e des Schlagvolumens (2). Weitere Faktoren der insgesamt reduzierten linksventrikulären Leistung sind diastolische Funktionsstörungen (13,14,15,42,50), rezidivierende Abstoßungsreaktionen, Zyklosporinassoziierte Hypertension sowie immunsuppressiv bedingte interstitielle Fibrose (17,31) und Koronarsklerose (36,46). Trotz limitierter Leistungsreserve verbessert sich bei transplantierten Patienten im Laufe der Zeit die Frequenzadaptation unter Belastung (28), was auf eine sympathische Reinnervation hinweist (3).…”