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Factors Associated With Sinoatrial Reinnervation After Heart Transplantation
Anders H Christensen1,2,3, Vegard B B Wyller2,4, Sissel Nygaard1,2
1Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Transplantation Direct
|November 6, 2023
Summary
Heart reinnervation improves over time after heart transplantation (HTx). Nonischemic cardiomyopathy and handgrip strength predict better sympathetic reinnervation, while reinnervation may reduce frailty and inflammation.
Area of Science:
- Cardiology
- Autonomic Nervous System Research
- Transplantation Science
Background:
- Sinoatrial reinnervation following heart transplantation (HTx) involves both sympathetic and parasympathetic components.
- Factors influencing this reinnervation process are not well understood.
- Understanding reinnervation is crucial for long-term outcomes in HTx recipients.
Purpose of the Study:
- To identify factors present at the initial visit that predict sinoatrial reinnervation after HTx.
- To explore the relationship between the degree of reinnervation and recipient characteristics over time.
- To generate hypotheses about the consequences of autonomic reinnervation post-transplantation.
Main Methods:
- Heart rate variability (HRV) was measured in 50 HTx recipients at multiple time points up to 36 months post-transplant.
- Low-frequency (LF) HRV, reflecting sympathetic and parasympathetic activity, and high-frequency (HF) HRV, reflecting parasympathetic activity, were assessed.
- Associations between HRV indices and pretransplant/perisurgical factors, as well as longitudinal recipient characteristics, were analyzed.
Main Results:
- Both LF and HF HRV increased significantly over the 36-month study period.
- Pretransplant nonischemic cardiomyopathy and higher handgrip strength at the index visit were associated with improved LF variability (sympathetic reinnervation).
- Higher average handgrip strength correlated with increased LF and HF variability, while higher C-reactive protein correlated with decreased variability.
Conclusions:
- Sinoatrial reinnervation, encompassing both sympathetic and parasympathetic functions, progresses over time after heart transplantation.
- Factors like nonischemic cardiomyopathy and handgrip strength are positive predictors of sympathetic reinnervation.
- Enhanced reinnervation may be linked to reduced frailty and inflammation, warranting further investigation into long-term clinical impact.
