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(Chest. 2002;122:1192-1199.)
© 2002 American College of Chest Physicians

Altered Sympathetic and Parasympathetic Activity in Lung Transplantation Patients at Rest and Following Autonomic Perturbation*

Amy Berakis, BSc; Trevor J. Williams, MD; Mathew T. Naughton, PhD; Jennifer H. Martin, MBBS; Michael Muhlmann, MBBS and Henry Krum, PhD

* From the Clinical Pharmacology Unit (Ms. Berakis, and Drs. Martin, Muhlmann, and Krum), Monash University Medical School, Prahran, Victoria, Australia; and the Department of Respiratory Medicine (Drs. Williams and Naughton), Alfred Hospital Melbourne, VIC, Australia.

Correspondence to: Henry Krum, PhD, Head of Clinical Pharmacology, Department of Epidemiology and Preventive Medicine, Monash Medical School, Alfred Hospital, Prahran, VIC 3181, Australia

Study objectives: To investigate the nature and extent of the alteration in autonomic function following heterotopic lung transplantation.

Design: Measures of cardiac parasympathetic nervous system activity (PNSA) and systemic sympathetic nervous system activity (SNSA) were compared in lung transplant patients and age-matched healthy subjects, both at rest and following autonomic perturbation.

Setting: Lung transplantation service of a university teaching hospital.

Patients and participants: Twenty-two lung transplant patients (mean [± SEM] age, 50.5 ± 2.4 years) and 13 healthy subjects (mean age, 48.2 ± 3.7 years).

Measurements and results: Lung transplant patients had decreased baseline time and frequency domain measures of heart rate variability compared to healthy subjects (root mean square of successive differences in R-R intervals, 11.2 ± 1.1 vs 30.3 ± 4.5 ms, respectively [p < 0.005]; LnHP, 2.4 ± 0.2 vs 4.8 ± 0.4 ms2, respectively [p < 0.005]). In addition, lung transplant patients demonstrated an attenuated reduction in LnHP/LnTP following head-up tilt in comparison to healthy subjects (p < 0.05). The baseline recumbent plasma norepinephrine level was increased in lung transplant patients compared to healthy subjects (3.25 ± 0.43 vs 2.00 ± 0.27 nmol/L, respectively; p < 0.05), and levels increased in both groups with upright head-up tilt. There were no differences between the two groups in heart rate or mean systolic BP responses to both the Valsalva maneuver and cold pressor testing.

Conclusions: Lung transplant patients have both reduced PNSA and increased SNSA at rest. Furthermore, these patients appear to have a preserved capacity to respond to autonomic perturbation by increasing SNSA. The mechanisms underlying these observations and their prognostic implications remain to be determined.

Key Words: autonomic • catecholamines • heart rate variability • lung transplantation






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