Cardiac dynamics during supine exercise in cyclosporine-treated orthotopic heart transplant recipients: assessment by radionuclide angiography
PW Pflugfelder,
PD Purves,
FN McKenzie,
and
WJ Kostuk
The mechanisms by which the denervated heart responds to supine exercise were assessed by equilibrium gated radionuclide angiography in 18 cardiac transplant recipients 1 to 25 months (mean 11) after surgery. Results were compared with those in 15 normal subjects. Exercise duration among transplant recipients did not differ significantly from that in normal subjects. The heart rate at rest in transplant patients was 30% higher than in normal volunteers. Heart rate increased only 3% between rest and the first stage of exercise in transplant recipients compared with a 37% increase in the normal group (p less than 0.001). Cardiac output at rest was similar in both groups although the rate of rise of cardiac output and peak cardiac output were significantly lower among the transplant recipients. In early exercise, the means by which cardiac output increased in the transplant patients differed significantly from normal. In the transplant recipients, the left ventricular end-diastolic volume index increased 14% compared with a decrease of 2% in normal subjects (p less than 0.001) during the first stage of exercise. At the same time, the end-systolic volume index increased 6% in the transplant group but decreased 11% in normal subjects (p less than 0.001). These changes resulted in an overall increase in stroke volume by 20% in the transplant group compared with only a slight increase (+3%) in normal subjects (p less than 0.001) during the first stage of exercise. Among transplant recipients, the stroke volume index plateaued after the first stage of exercise, which, in combination with the blunted chronotropic response, resulted in a peak cardiac index 25% lower than that in normal subjects (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
