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Simonenko M, Hansen D, Niebauer J, Volterrani M, Adamopoulos S, Amarelli C, Ambrosetti M, Anker SD, Bayes-Genis A, Gal TB, Bowen TS, Cacciatore F, Caminiti G, Cavaretta E, Chioncel O, Coats AJS, Cohen-Solal A, D'Ascenzi F, de Pablo Zarzosa C, Gevaert AB, Gustafsson F, Kemps H, Hill L, Jaarsma T, Jankowska E, Joyce E, Krankel N, Lainscak M, Lund LH, Moura B, Nytrøen K, Osto E, Piepoli M, Potena L, Rakisheva A, Rosano G, Savarese G, Seferovic PM, Thompson DR, Thum T, Van Craenenbroeck EM. Prevention and rehabilitation after heart transplantation: A clinical consensus statement of the European Association of Preventive Cardiology, Heart Failure Association of the ESC, and the European Cardio Thoracic Transplant Association, a section of ESOT. Eur J Prev Cardiol 2024:zwae179. [PMID: 38894688 DOI: 10.1093/eurjpc/zwae179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 01/20/2024] [Accepted: 02/21/2024] [Indexed: 06/21/2024]
Abstract
Little is known either about either physical activity patterns, or other lifestyle-related prevention measures in heart transplantation (HTx) recipients. The history of HTx started more than 50 years ago but there are still no guidelines or position papers highlighting the features of prevention and rehabilitation after HTx. The aims of this scientific statement are (i) to explain the importance of prevention and rehabilitation after HTx, and (ii) to promote the factors (modifiable/non-modifiable) that should be addressed after HTx to improve patients' physical capacity, quality of life and survival. All HTx team members have their role to play in the care of these patients and multidisciplinary prevention and rehabilitation programmes designed for transplant recipients. HTx recipients are clearly not healthy disease-free subjects yet they also significantly differ from heart failure patients or those who are supported with mechanical circulatory support. Therefore, prevention and rehabilitation after HTx both need to be specifically tailored to this patient population and be multidisciplinary in nature. Prevention and rehabilitation programmes should be initiated early after HTx and continued during the entire post-transplant journey. This clinical consensus.
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Affiliation(s)
- Maria Simonenko
- Cardiopulmonary Exercise Test Research Department, Heart Transplantation Outpatient Department, V.A. Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Dominique Hansen
- REVAL and BIOMED Rehabilitation Research Center, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | | | - Stamatis Adamopoulos
- Heart Failure and Heart Transplantation Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Cristiano Amarelli
- Department of Cardiac Surgery and Transplants, Monaldi Hospital, Azienda dei Colli, Naples, Italy
| | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Santa Marta Hospital, Rivolta d'Adda (CR), Italy
| | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Scott Bowen
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Francesco Cacciatore
- Department of Translational Medicine, University of Naples 'Federico II', Naples, Italy
| | | | - Elena Cavaretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania
- University of Medicine Carol Davila, Bucharest, Romania
| | | | - Alain Cohen-Solal
- Cardiology Department, University of Paris, INSERM UMRS-942, Hopital Lariboisiere, AP-HP, Paris, France
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | | | - Andreas B Gevaert
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, Eindhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden
- Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Emer Joyce
- Department of Cardiology, Mater University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Nicolle Krankel
- Universitätsmedizin Berlin Campus Benjamin Franklin Klinik für Kardiologie Charite, Berlin, Germany
| | | | - Lars H Lund
- Department of Medicine, Karolinska Institutet and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Brenda Moura
- Armed Forces Hospital, Porto, Portugal
- Centre for Health Technologies and Services Research, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Kari Nytrøen
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Elena Osto
- Division of Physiology and Pathophysiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Graz, Austria
- Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Massimo Piepoli
- Dipartimento Scienze Biomediche per la Salute, Universita' Degli Studi di Milan, Milan, Italy
- Cardiologia Universitaria, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Amina Rakisheva
- Department of Cardiology, Scientific Institution of Cardiology and Internal Diseases, Almaty, Kazakhstan
- Department of Cardiology, Kapshagai City Hospital, Almaty, Kazakhstan
| | - Giuseppe Rosano
- St. George's Hospital NHS Trust University of London, London, UK
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Petar M Seferovic
- Faculty of Medicine and Heart Failure Center, University of Belgrade, Belgrade University Medical Center, Belgrade, Serbia
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School and Fraunhofer Institute for Toxicology and Experimental Research, Hannover, Germany
| | - Emeline M Van Craenenbroeck
- Research Group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
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Foulkes SJ, Hewitt D, Peters A, Schmidt T, Reiss N, Riess K, Paterson S, La Gerche A, Haykowsky MJ. Effect of Exercise Training on Peak Aerobic Power After Heart Transplantation: A Brief Review. Can J Cardiol 2023; 39:S368-S374. [PMID: 37480990 DOI: 10.1016/j.cjca.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023] Open
Abstract
Heart transplantation (HTP) is a life-saving therapy for selected individuals with end-stage refractory heart failure. Despite improvements in quality of life and survival, HTP recipients' peak aerobic power (peak VO2) remains up to 50% lower than age-matched healthy control subjects owing to abnormal cardiovascular and skeletal muscle function. Currently, little is known regarding the effect of exercise training (ET) to improve peak VO2 after HTP. This brief review aims to summarise existing evidence regarding the role of ET on peak VO2 and its determinants, highlights the upper limits of endurance performance in highly trained HTP athletes, and identifies areas for future HTP exercise rehabilitation research.
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Affiliation(s)
- Stephen J Foulkes
- College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia
| | - Dean Hewitt
- College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | | | - Thomas Schmidt
- Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany; Institute for Cardiology and Sports Medicine, German Sports University Cologne, Cologne, Germany
| | - Nils Reiss
- Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Ken Riess
- College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada; Northern Alberta Institute of Technology, Edmonton, Alberta, Canada
| | - Sarah Paterson
- College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, Victoria, Australia
| | - Mark J Haykowsky
- College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
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Schmidt T, Reiss N, Olbrich E, Chalabi K, Hagedorn T, Tetzlaff K. Scuba diving after a heart transplant: excessive daring or calculable risk? Am J Physiol Heart Circ Physiol 2023; 325:H569-H577. [PMID: 37477692 DOI: 10.1152/ajpheart.00332.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023]
Abstract
Over the past 50 years, outcomes after heart transplantation (HTX) have continuously and significantly improved. In the meantime, many heart transplant recipients live almost normal lives with only a few limitations. In some cases, even activities that actually seemed unreasonable for these patients turn out to be feasible. This article describes the encouraging example of a patient returning to recreational scuba diving after HTX. So far, there were no scientific experiences documented in this area. We worked out the special hemodynamic features and the corresponding risks of this sport for heart transplant recipients in an interdisciplinary manner and evaluated them using the patient as an example. The results show that today, with the appropriate physical condition and compliance with safety measures, a wide range of activities, including scuba diving, are possible again after HTX. They illustrate again the significant development and the enormous potential of this therapy option, which is unfortunately only available to a limited extent.NEW & NOTEWORTHY Example for shared decision-making process for tricky questions: First scientific publication about heart transplantation (HTX)-recipient restarting scuba diving. As exercise physiology after HTX combined with specific diving medicine aspects is challenging, we formed a multidisciplinary team to identify, evaluate, and mitigate the risks involved. The results show that today, with the appropriate physical condition and compliance with safety measures, a wide range of activities are possible again after HTX.
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Affiliation(s)
- Thomas Schmidt
- Institute for Cardiology and Sports Medicine, German Sports University Cologne, Cologne, Germany
- Institute for Cardiovascular Research, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Nils Reiss
- Institute for Cardiovascular Research, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Erk Olbrich
- Department of Cardiac Surgery, INCCI Haerz-Zenter, Luxembourg, Luxembourg
| | - Khaled Chalabi
- Department of Cardiac Surgery, INCCI Haerz-Zenter, Luxembourg, Luxembourg
| | - Thorsten Hagedorn
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Kay Tetzlaff
- Department of Sports Medicine, University Hospital Tuebingen, Tuebingen, Germany
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Youn JC, Kim D, Cho JY, Cho DH, Park SM, Jung MH, Hyun J, Cho HJ, Park SM, Choi JO, Chung WJ, Yoo BS, Kang SM. Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Treatment. Korean Circ J 2023; 53:217-238. [PMID: 37161681 PMCID: PMC10172201 DOI: 10.4070/kcj.2023.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/22/2023] [Accepted: 04/04/2023] [Indexed: 05/11/2023] Open
Abstract
The Korean Society of Heart Failure (KSHF) guidelines aim to provide physicians with evidence-based recommendations for the management of patients with heart failure (HF). After the first introduction of the KSHF guidelines in 2016, newer therapies for HF with reduced ejection fraction, HF with mildly reduced ejection fraction, and HF with preserved ejection fraction have since emerged. The current version has been updated based on international guidelines and research data on Korean patients with HF. Herein, we present Part II of these guidelines, which comprises treatment strategies to improve the outcomes of patients with HF.
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Affiliation(s)
- Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang Min Park
- Department of Cardiology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Junho Hyun
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Jai Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Byung-Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seok-Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Youn JC, Kim D, Cho JY, Cho DH, Park SM, Jung MH, Hyun J, Cho HJ, Park SM, Choi JO, Chung WJ, Yoo BS, Kang SM. Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Treatment. INTERNATIONAL JOURNAL OF HEART FAILURE 2023; 5:66-81. [PMID: 37180564 PMCID: PMC10172080 DOI: 10.36628/ijhf.2023.0011] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/17/2023] [Accepted: 03/27/2023] [Indexed: 05/16/2023]
Abstract
The Korean Society of Heart Failure (KSHF) guidelines aim to provide physicians with evidence-based recommendations for the management of patients with heart failure (HF). After the first introduction of the KSHF guidelines in 2016, newer therapies for HF with reduced ejection fraction, HF with mildly reduced ejection fraction, and HF with preserved ejection fraction have since emerged. The current version has been updated based on international guidelines and research data on Korean patients with HF. Herein, we present Part II of these guidelines, which comprises treatment strategies to improve the outcomes of patients with HF.
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Affiliation(s)
- Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang Min Park
- Department of Cardiology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Junho Hyun
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Jai Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Byung-Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seok-Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Effect of Physical Training on the Morphology of Parasympathetic Atrial Ganglia after Unilateral Vagotomy in Rats. J Cardiovasc Dev Dis 2022; 9:jcdd9110391. [DOI: 10.3390/jcdd9110391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/30/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiac denervation is a serious problem in a number of patients, including patients after heart transplantation. The status of the parasympathetic ganglia after crossing the preganglionic fibers of the vagus nerve has not been enough studied. The aim of our study was to assess the effect of physical training on the morphological parameters of the parasympathetic atrial ganglia and autonomic regulation of heart rate after right- and left-sided vagotomy in rats. Morphometric characteristics of the right atrial ganglia were evaluated using an immunohistochemical method after a study that included a three-time assessment of heart rate variability. It was found that right-sided vagotomy leads to both an increase in the volume of ganglion and autonomic dysfunction. No significant change in the number of nerve cells was found in animals with false and left-sided vagotomy while maintaining preganglionic innervation after the physical training, whereas exercises led to a decrease in the volume of nerve tissue of rats with right-sided denervation. It was also found that in animals with preserved vagal innervation, the volume of atrial ganglion tissue correlates with overall heart rate variability and a normalized parasympathetic component. Therefore, a positive effect from regular physical activity on parasympathetic regulation can be expected only if preganglionic vagal influence is preserved.
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Schmidt T, Kowalski M, Bjarnason-Wehrens B, Ritter F, Mönnig G, Reiss N. Feasibility of inpatient cardiac rehabilitation after percutaneous mitral valve reconstruction using clipping procedures: a retrospective analysis. BMC Sports Sci Med Rehabil 2022; 14:120. [PMID: 35787297 PMCID: PMC9254646 DOI: 10.1186/s13102-022-00517-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/13/2022] [Indexed: 11/24/2022]
Abstract
Background To date, no studies on the feasibility or outcomes of cardiac rehabilitation (CR) after percutaneous mitral valve reconstruction using clipping procedures have been published. The aim of this study was to report on our first experiences with this special target group. Methods Monocentric retrospective analysis of 27 patients (72 ± 12 years old, 52% female) who underwent multimodal inpatient CR in the first 2 month after MitraClip™ implantation. A six-minute-walking-test, a handgrip-strength-test and the Berg-Balance-Scale was conducted at the beginning and end of CR. Echocardiography was performed to rule out device-related complications. Results Adapted inpatient CR started 16 ± 13 days after clipping intervention and lasted 22 ± 4 days. In 4 patients (15%) CR had to be interrupted or aborted prematurely due to cardiac decompensations. All other patients (85%) completed CR period without complications. Six-minute-walking-distance improved from 272 ± 97 to 304 ± 111 m (p < .05) and dependence on rollator walker or walking aids was significantly reduced (p < .05). Results of handgrip-strength-test and Berg-Balance-Scale increased (p < .05). Overall, social-medical and psychological consultations were well received by the patients and no device-related complications occurred during rehabilitation treatments. Conclusions The results indicate that an adapted inpatient CR in selected patients after MitraClip™ implantation is feasible. Patients benefited from treatments both at functional and social-medical level and no device-related complications occurred. Larger controlled studies are needed.
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Affiliation(s)
- Thomas Schmidt
- Institute for Cardiovascular Research, Schüchtermann-Klinik Bad Rothenfelde, Ulmenallee 5-11, 49214, Bad Rothenfelde, Germany. .,Department of Preventive and Rehabilitative Sport and Exercise Medicine, Institute for Cardiology and Sports Medicine, German Sports University Cologne, Am Sportpark Müngerdorf 6, 50933, Cologne, Germany.
| | - Marek Kowalski
- Institute for Cardiovascular Research, Schüchtermann-Klinik Bad Rothenfelde, Ulmenallee 5-11, 49214, Bad Rothenfelde, Germany
| | - Birna Bjarnason-Wehrens
- Department of Preventive and Rehabilitative Sport and Exercise Medicine, Institute for Cardiology and Sports Medicine, German Sports University Cologne, Am Sportpark Müngerdorf 6, 50933, Cologne, Germany
| | - Frank Ritter
- Institute for Cardiovascular Research, Schüchtermann-Klinik Bad Rothenfelde, Ulmenallee 5-11, 49214, Bad Rothenfelde, Germany
| | - Gerold Mönnig
- Institute for Cardiovascular Research, Schüchtermann-Klinik Bad Rothenfelde, Ulmenallee 5-11, 49214, Bad Rothenfelde, Germany
| | - Nils Reiss
- Institute for Cardiovascular Research, Schüchtermann-Klinik Bad Rothenfelde, Ulmenallee 5-11, 49214, Bad Rothenfelde, Germany
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Kourek C, Karatzanos E, Nanas S, Karabinis A, Dimopoulos S. Exercise training in heart transplantation. World J Transplant 2021; 11:466-479. [PMID: 34868897 PMCID: PMC8603635 DOI: 10.5500/wjt.v11.i11.466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/12/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
Heart transplantation remains the gold standard in the treatment of end-stage heart failure (HF). Heart transplantation patients present lower exercise capacity due to cardiovascular and musculoskeletal alterations leading thus to poor quality of life and reduction in the ability of daily self-service. Impaired vascular function and diastolic dysfunction cause lower cardiac output while decreased skeletal muscle oxidative fibers, enzymes and capillarity cause arteriovenous oxygen difference, leading thus to decreased peak oxygen uptake in heart transplant recipients. Exercise training improves exercise capacity, cardiac and vascular endothelial function in heart transplant recipients. Pre-rehabilitation regular aerobic or combined exercise is beneficial for patients with end-stage HF awaiting heart transplantation in order to maintain a higher fitness level and reduce complications afterwards like intensive care unit acquired weakness or cardiac cachexia. All hospitalized patients after heart transplantation should be referred to early mobilization of skeletal muscles through kinesiotherapy of the upper and lower limbs and respiratory physiotherapy in order to prevent infections of the respiratory system prior to hospital discharge. Moreover, all heart transplant recipients after hospital discharge who have not already participated in an early cardiac rehabilitation program should be referred to a rehabilitation center by their health care provider. Although high intensity interval training seems to have more benefits than moderate intensity continuous training, especially in stable transplant patients, individualized training based on the abilities and needs of each patient still remains the most appropriate approach. Cardiac rehabilitation appears to be safe in heart transplant patients. However, long-term follow-up data is incomplete and, therefore, further high quality and adequately-powered studies are needed to demonstrate the long-term benefits of exercise training in this population.
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Affiliation(s)
- Christos Kourek
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, Evaggelismos Hospital, Athens 10676, Attica, Greece
| | - Eleftherios Karatzanos
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, Evaggelismos Hospital, Athens 10676, Attica, Greece
| | - Serafim Nanas
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, Evaggelismos Hospital, Athens 10676, Attica, Greece
| | - Andreas Karabinis
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Stavros Dimopoulos
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, Evaggelismos Hospital, Athens 10676, Attica, Greece
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
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