Mechanisms behind the postprandial increase in cardiac output: a clue obtained from transplanted hearts.

Consumption of a meal is followed by an increase in cardiac output (CO) which appears to be closely related to the concomitant increase in blood flow to the gastrointestinal organs. To gain information on the mechanism behind this increase in CO we have previously used Doppler ultrasound technique to record circulatory responses to a standardized meal in five patients with recently transplanted and thus denervated hearts. We obtained the surprising result that they reacted to the consumption of a meal with a greater increase in CO than did five matched normal controls. The patients also presented above-normal levels of heart rate (HR) and CO at rest. The same five patients have now been tested 18 months later to re-examine their remarkable cardiac response to ingestion of a meal. The hearts of two patients showed some signs of reinnervation, whereas the hearts of the other three were apparently still fully denervated. However, all five patients once again evolved a marked cardiac response to ingestion of a meal. Postprandial CO reached significantly higher levels in the patients than in the controls. The persistence of such a pronounced postprandial augmentation of CO in transplanted and largely denervated hearts strengthens the assumption that the heart is induced to increase its postprandial performance through the action of a humoral agent of some sort, possibly one of the hormones from the duodenal-pancreatic region.