Why the study?
Evidence on the acute and chronic effects of lung transplantation on cardiac autonomic modulation was limited.
Does bilateral lung transplantation alter cardiac autonomic modulation in patients awaiting transplant?
Does bilateral lung transplantation alter cardiac autonomic modulation in patients awaiting transplant?
Bilateral lung transplantation leads to a sustained reduction in global variability and complexity of cardiac autonomic modulation, characterized by sympathetic predominance and vagal withdrawal up to 6 months post-surgery.
BLT was associated with reduced global autonomic modulation and sympathetic shift; hypothesis-generating for post-transplant arrhythmia risk and needs confirmation.
BACKGROUND: Although cardiac autonomic modulation has been studied in several respiratory diseases, the evidence is limited on lung transplantation, particularly on its acute and chronic effects. Thus, we aimed to evaluate cardiac autonomic modulation before and after bilateral lung transplantation (BLT) through a prospective study on patients enrolled while awaiting transplant. METHODS: Twenty-two patients on the waiting list for lung transplantation (11 women, age 33 [24-51] years) were enrolled in a prospective study at Ospedale Maggiore Policlinico Hospital in Milan, Italy. To evaluate cardiac autonomic modulation, ten minutes ECG and respiration were recorded at different time points before (T0) and 15 days (T1) and 6 months (T2) after bilateral lung transplantation. As to the analysis of cardiac autonomic modulation, heart rate variability (HRV) was assessed using spectral and symbolic analysis. Entropy-derived measures were used to evaluate complexity of cardiac autonomic modulation. Comparisons of autonomic indices at different time points were performed. RESULTS: BLT reduced HRV total power, HRV complexity and vagal modulation, while it increased sympathetic modulation in the acute phase (T1) compared to baseline (T0). The HRV alterations remained stable after 6 months (T2). CONCLUSION: BLT reduced global variability and complexity of cardiac autonomic modulation in acute phases, and these alterations remain stable after 6 months from surgery. After BLT, a sympathetic predominance and a vagal withdrawal could be a characteristic autonomic pattern in this population.
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Tobaldini et al. (2021) studied this question.
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