1
|
Barker K, Rydberg L, Lanphere J, Malmut L, Neal J, Eickmeyer S. The utility of inpatient rehabilitation in heart transplantation: A review. Clin Transplant 2024; 38:e15182. [PMID: 37922201 DOI: 10.1111/ctr.15182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/18/2023] [Accepted: 10/27/2023] [Indexed: 11/05/2023]
Abstract
Heart transplantation is considered definitive treatment for patients with end-stage heart failure. Unfortunately, medical and functional complications are common after heart transplantation for a variety of reasons, and these may impact the patients' functional recovery. Rehabilitation is often needed post-operatively to improve functional outcomes. This review article aims to discuss the transplanted heart exercise physiology that may affect the rehabilitation process and provide an overview of the functional benefits of inpatient rehabilitation for cardiac and surgical specialties who may be less familiar with post-acute care rehabilitation options for their patients.
Collapse
Affiliation(s)
- Kim Barker
- UT Southwestern Medical Center, Dallas, Texas, USA
| | - Leslie Rydberg
- Northwestern University Feinberg School of Medicine, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | | | - Laura Malmut
- MedStar National Rehabilitation Network, Washington, USA
- Department of Physical Medicine and Rehabilitation, Georgetown University School of Medicine, Washington, USA
| | - Jacqueline Neal
- Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah Eickmeyer
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, USA
| |
Collapse
|
2
|
Rydberg L, Barker K, Lanphere J, Malmut L, Neal J, Eickmeyer S. Heart transplantation and the role of inpatient rehabilitation: A narrative review. PM R 2023; 15:1351-1360. [PMID: 36565450 DOI: 10.1002/pmrj.12935] [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: 04/29/2022] [Revised: 11/25/2022] [Accepted: 12/02/2022] [Indexed: 12/25/2022]
Abstract
Heart transplantation is a definitive treatment option for patients with end-stage heart failure. Medical and functional complications are common after this procedure, and rehabilitation is often needed postoperatively. Physiatrists caring for persons who have received a donor heart must appreciate the surgical background, the physiologic changes expected, as well as the potential medical complications for which they are at risk after heart transplantation. This review summarizes various topics in heart transplantation including the history of the procedure, exercise physiology and functional outcomes, postoperative medical therapy, medical complications, and special considerations for inpatient rehabilitation in this patient population.
Collapse
Affiliation(s)
- Leslie Rydberg
- Shirley Ryan AbilityLab, Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kim Barker
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Julie Lanphere
- T12 Neuro Specialty Rehab Unit at Intermountain Medical Center, Murray, Utah, USA
| | - Laura Malmut
- MedStar National Rehabilitation Network, Washington, District of Columbia, USA
| | - Jacqueline Neal
- Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah Eickmeyer
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| |
Collapse
|
3
|
Zhang RS, Hanff TC, Zhang Y, Genuardi MV, Peters CJ, Levin A, Molina M, McLean RC, Mazurek JA, Zamani P, Tanna MS, Wald J, Santangeli P, Atluri P, Goldberg LR, Birati EY. Chronotropic Incompetence after Heart Transplantation Is Associated with Increased Mortality and Decreased Functional Capacity. J Clin Med 2023; 12:jcm12103487. [PMID: 37240595 DOI: 10.3390/jcm12103487] [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: 03/12/2023] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION The contribution of chronotropic incompetence to reduced exercise tolerance after a heart transplant is well known, but its role as a prognostic marker of post-transplant mortality is unclear. The aim of this study is to examine the relationship between post-transplant heart rate response (HRR) and survival. METHODS We performed a retrospective analysis of all adult heart transplant recipients at the University of Pennsylvania between the years 2000 and 2011 who underwent a cardiopulmonary exercise test (CPET) within a year of transplant. Follow-up time and survival status were observed through October 2019, using data merged from the Penn Transplant Institute. HRR was calculated by subtracting the resting HR from the peak exercise HR. The association between HRR and mortality was analyzed using Cox proportional hazard models and Kaplan-Meier analysis. The optimal cut-off point for HRR was generated by Harrell's C statistic. Patients with submaximal exercise tests were excluded, defined by a respiratory exchange ratio (RER) cut-off of 1.05. RESULTS Of 277 patients with CPETs performed within a year post-transplant, 67 were excluded for submaximal exercise. In the 210 included patients, the mean follow-up time was 10.9 years (Interquartile range (IQR) 7.8-14). Resting HR and peak HR did not significantly impact mortality after adjusting for covariates. In a multivariable linear regression analysis, each 10-beat increase in heart rate response was associated with a 1.3 mL/kg/min increase in peak VO2 and a 48 s increase in the total exercise time. Each beat/min increase in HRR was associated with a 3% reduction in the hazard of mortality (HR 0.97; 95% CI 0.96-0.99, p = 0.002). Using the optimal cut-off point generated by Harrell's C statistic, survival was significantly higher in patients with an HRR > 35 beats/min compared to those with an HRR < 35 beats/min (log rank p = 0.0012). CONCLUSION In heart transplant patients, a low HRR is associated with increased all-cause mortality and decreased exercise capacity. Additional studies are needed to validate whether targeting HRR in cardiac rehabilitation may improve outcomes.
Collapse
Affiliation(s)
- Robert S Zhang
- Division of Cardiovascular Medicine, NYU Langone Health, New York, NY 10016, USA
| | - Thomas C Hanff
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
- Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
| | - Yuhui Zhang
- Fuwai Hospital, Peking Union Medical College, Beijing 100005, China
| | - Michael V Genuardi
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
- Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
| | - Carli J Peters
- Division of Cardiovascular Medicine, NYU Langone Health, New York, NY 10016, USA
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
| | - Allison Levin
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
| | - Maria Molina
- Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
| | - Rhondalyn C McLean
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
- Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
| | - Jeremy A Mazurek
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
- Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
| | - Payman Zamani
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
- Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
| | - Monique S Tanna
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
- Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
| | - Joyce Wald
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
- Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
| | - Pasquale Santangeli
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
- Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
| | - Pavan Atluri
- Department of Cardiothoracic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19123, USA
| | - Lee R Goldberg
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
- Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
| | - Edo Y Birati
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
- Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19123, USA
- The Lydia and Carol Kittner, Lea and Banjamin Davidai Division of Cardiovascular Medicine and Surgery, Padeh-Poriya Medical Center, Tiberias 1528001, Israel
| |
Collapse
|
4
|
Costa R, Moreira E, Silva Cardoso J, Azevedo LF, Ribeiro JA, Pinto R. Effectiveness of Exercise-Based Cardiac Rehabilitation for Heart Transplant Recipients: A Systematic Review and Meta-Analysis. Health Serv Insights 2023; 16:11786329231161482. [PMID: 36968658 PMCID: PMC10034295 DOI: 10.1177/11786329231161482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/16/2023] [Indexed: 03/24/2023] Open
Abstract
Background Heart Transplant (HTx) is the ultimate chance of life for end stage Heart Failure (HF). Exercise training has consistently shown the potential to improve functional capacity in various chronic heart diseases. Still, the evidence in HTx recipients is scarcer. This study aims to systematically review the literature to evaluate the effectiveness and safety of Exercise-based Cardiac Rehabilitation (EBCR) in HTx recipients and to identify possible moderators of success. Methods We conducted a systematic review and meta-analysis of randomized controlled trials on the effect and safety of EBCR in adult HTx recipients. The primary outcome was functional capacity, measured by Peak Oxygen Uptake (pVO2). We searched CENTRAL, MEDLINE, Embase, Scopus, and Web of Knowledge databases until December 2020, reviewed references of relevant articles and contacted experts. Usual care (UC), the different dosages of exercise regimens and alternative settings were allowed as comparators. A quantitative synthesis of evidence was performed using random-effects meta-analyses. Results A total of 11 studies with 404 patients were included. Nine studies comprising 306 patients compared EBCR with usual care. They showed that EBCR improved pVO2 compared to usual care (Mean Difference [MD] 3.03 mL/kg/min, 95% CI [2.28-3.77]; I 2 = 32%). In the subgroup analysis, including length of intervention and timing of enrollment after HTx, no significant moderator was found. Two trials, with 98 patients total, compared High Intensity Interval Training (HIIT) and Moderate Intensity Continuous Training (MICT). HIIT attained a significant edge over MICT (MD 2.23 mL/kg/min, 95% CI [1.79-2.67]; I 2 = 0%). No major adverse events associated with EBCR were reported. Conclusion We found moderate quality evidence suggesting EBCR has a significant benefit on functional capacity improvement HTx recipients at the short-term. HIIT showed superiority when compared to MICT. Research focusing long term outcomes and standardized protocols are needed to improve evidence on EBCR effectiveness.
Collapse
Affiliation(s)
- Rúben Costa
- Faculty of Medicine, University of
Porto, Porto, Portugal
- Department of Dermatology and
Venereology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Emília Moreira
- CINTESIS, Centre for Health Technology
and Services Research, Faculty of Medicine, University of Porto, Porto,
Portugal
- RISE: Health Research Network
| | - José Silva Cardoso
- CINTESIS, Centre for Health Technology
and Services Research, Faculty of Medicine, University of Porto, Porto,
Portugal
- RISE: Health Research Network
- Department of Medicine, Faculty of
Medicine, University of Porto, Porto, Portugal
- Department of Cardiology, Centro
Hospitalar Universitário de São João, Porto, Portugal
| | - Luís Filipe Azevedo
- CINTESIS, Centre for Health Technology
and Services Research, Faculty of Medicine, University of Porto, Porto,
Portugal
- RISE: Health Research Network
- Department of Community Medicine,
Information and Health Decision Sciences, Faculty of Medicine, University of Porto,
Portugal
| | - João Alves Ribeiro
- Faculty of Engineering, University of
Porto, Porto, Portugal
- MIT Portugal Ph.D. candidate, Faculty
of Engineering, University of Porto, Porto, Portugal
| | - Roberto Pinto
- Department of Cardiology, Centro
Hospitalar Universitário de São João, Porto, Portugal
- Department of Biomedicine, Faculty of
Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
5
|
Guía ESC 2020 sobre cardiología del deporte y el ejercicio en pacientes con enfermedad cardiovascular. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
6
|
Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, Collet JP, Corrado D, Drezner JA, Halle M, Hansen D, Heidbuchel H, Myers J, Niebauer J, Papadakis M, Piepoli MF, Prescott E, Roos-Hesselink JW, Graham Stuart A, Taylor RS, Thompson PD, Tiberi M, Vanhees L, Wilhelm M. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J 2021; 42:17-96. [PMID: 32860412 DOI: 10.1093/eurheartj/ehaa605] [Citation(s) in RCA: 768] [Impact Index Per Article: 256.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
7
|
Schumacher O, Trachsel LD, Herzig D, Mohacsi P, Sigurdardottir V, Wilhelm M, Eser P. Heart rate kinetics during standard cardiopulmonary exercise testing in heart transplant recipients: a longitudinal study. ESC Heart Fail 2021; 8:1096-1105. [PMID: 33417294 PMCID: PMC8006603 DOI: 10.1002/ehf2.13102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/09/2020] [Accepted: 10/22/2020] [Indexed: 12/23/2022] Open
Abstract
AIMS Heart transplantation (HTx) results in complete autonomic denervation of the donor heart, causing resting tachycardia and abnormal heart rate (HR) responses to exercise. We determined the time course of suggestive cardiac reinnervation post HTx and investigated its clinical significance. METHODS AND RESULTS Heart rate kinetics during standard cardiopulmonary exercise testing at 2.5-5 years after HTx was assessed in 58 patients. According to their HR increase 30 s after exercise onset, HTx recipients were classified as denervated (slow responders: <5 beats per minute [b.p.m.]) or potentially reinnervated (fast responders: ≥5 b.p.m.). Additionally, in 30 patients, longitudinal changes of maximal oxygen consumption and HR kinetics were assessed during the first 15 post-operative years. At 2.5-5 years post HTx, 38% of our study population was potentially reinnervated. Fast responders were significantly younger (41 ± 15 years) than slow responders (53 ± 13 years, P = 0.003) but did not differ with regard to donor age, immunosuppressive regime, cardiovascular risk factors, endomyocardial biopsy, or vasculopathy parameters. While HR reserve (56 ± 20 vs. 39 ± 15 b.p.m., P = 0.002) and HR recovery after 60 s (15 ± 11 vs. 5 ± 6 b.p.m., P < 0.001) were greater in fast responders, resting HR, peak HR of predicted, and peak oxygen consumption of predicted were comparable. CONCLUSIONS Signs of reinnervation occurred mainly in younger patients. Maximal oxygen consumption was independent of HR kinetics.
Collapse
Affiliation(s)
- Oliver Schumacher
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
- Exercise Physiology Lab, Institute of Human Movement Sciences and SportETH ZurichZurichSwitzerland
| | - Lukas D. Trachsel
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - David Herzig
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Paul Mohacsi
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Vilborg Sigurdardottir
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Prisca Eser
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| |
Collapse
|
8
|
Schmidt T, Bjarnason-Wehrens B, Predel HG, Reiss N. Exercise after Heart Transplantation: Typical Alterations,
Diagnostics and Interventions. Int J Sports Med 2020; 42:103-111. [DOI: 10.1055/a-1194-4995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AbstractFor the treatment of terminal heart failure, heart transplantation is considered
to be the gold standard, leading to significantly improved quality of life and
long-time survival. For heart transplant recipients, the development and
maintenance of good functional performance and adequate exercise capacity is
crucial for renewed participation and integration in self-determined live. In
this respect, typical transplant-related alterations must be noted that play a
significant role, leading to restrictions both centrally and peripherally.
Before patients begin intensive and structured exercise training, a
comprehensive diagnosis of their exercise capacity should take place in order to
stratify the risks involved and to plan the training units accordingly.
Particularly endurance sports and resistance exercises are recommended to
counter the effects of the underlying disease and the immunosuppressive
medication. The performance level achieved can vary considerably depending on
their individual condition, from gentle activity through a non-competitive-level
to intensive competitive sports. This paper includes an overview of the current
literature on heart transplant recipients, their specific characteristics, as
well as typical cardiovascular and musculoskeletal alterations. It also
discusses suitable tools for measuring exercise capacity, recommendations for
exercise training, required precautions and the performance level usually
achieved.
Collapse
Affiliation(s)
- Thomas Schmidt
- Institute for Cardiovascular Research, Schüchtermann-Klinik Bad
Rothenfelde, Bad Rothenfelde, Germany
- Department of Preventive and Rehabilitative Sport and Exercise
Medicine, Institute for Cardiology and Sports Medicine, Cologne, German Sport
University Cologne, Germany
| | - Birna Bjarnason-Wehrens
- Department of Preventive and Rehabilitative Sport and Exercise
Medicine, Institute for Cardiology and Sports Medicine, Cologne, German Sport
University Cologne, Germany
| | - Hans-Georg Predel
- Department of Preventive and Rehabilitative Sport and Exercise
Medicine, Institute for Cardiology and Sports Medicine, Cologne, German Sport
University Cologne, Germany
| | - Nils Reiss
- Institute for Cardiovascular Research, Schüchtermann-Klinik Bad
Rothenfelde, Bad Rothenfelde, Germany
| |
Collapse
|
9
|
Uithoven KE, Smith JR, Medina-Inojosa JR, Squires RW, Van Iterson EH, Olson TP. The Influence of Sex Differences on Cardiopulmonary Exercise Metrics Following Heart Transplant. Can J Cardiol 2019; 36:54-59. [PMID: 31607508 DOI: 10.1016/j.cjca.2019.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Previous work has shown sex-related differences in cardiopulmonary responses in patients with heart failure (HF); however, sex differences following heart transplant (HTx) have not been examined. Thus, we hypothesized women would demonstrate lower peak oxygen uptake (VO2peak) but similar ventilatory efficiency (VE/VCO2 slope) compared with men prior to HTx. Furthermore, we hypothesized that, following HTx, women would exhibit greater improvements in VO2peak and VE/VCO2 slope compared with men. METHODS HTx patients with cardiopulmonary exercise testing (CPET) between 2007 and 2016 were included. Pre-HTx CPET occurred within 24 months pre-HTx with post-HTx CPET within 12 months following HTx. VO2peak was measured via standard protocol. VE/VCO2 slope was calculated using rest-peak ventilation (VE) and carbon dioxide production (VCO2). RESULTS Eighty-eight patients (Men [M]: n = 63, age: 55 ± 12 years; Women [W]: n = 25, age: 47 ± 11 years) were assessed. Pre-HTx VO2peak (M: 13.9 ± 5.0 vs W: 11.6 ± 3.9 mL/kg/min, P = 0.17) and VE/VCO2 slope (M: 42 ± 12 vs W: 46 ± 18, P = 0.53) were not different between sexes. Overall, VO2peak (Pre: 13.3 ± 4.8 vs Post: 18.4 ± 4.8 mL/kg/min, P < 0.01) and VE/VCO2 slope (Pre: 43 ± 14 vs Post: 37 ± 6, P = 0.02) improved following HTx. Post-VO2peak (M: 19.0 ± 4.8 vs W: 16.8 ± 4.5 mL/kg/min, P = 0.24) and VE/VCO2 slope (M: 37 ± 6 vs W: 37 ± 7, P = 0.99) and delta VO2peak (M: 5.0 ± 4.8 vs W: 5.3 ± 4.9 mL/kg/min, P = 0.85) and VE/VCO2 slope (M: -5 ± 11 vs W: -9 ± 17, P = 0.29) were not different between sexes. CONCLUSIONS These data demonstrate that cardiopulmonary improvements following HTx patients occur for both sexes. Importantly, women show similar significant functional improvements following HTx compared with men.
Collapse
Affiliation(s)
- Katelyn E Uithoven
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA.
| | - Joshua R Smith
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jose R Medina-Inojosa
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ray W Squires
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Erik H Van Iterson
- Section of Preventive Cardiology and Rehabilitation, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas P Olson
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
10
|
Uithoven KE, Smith JR, Medina-Inojosa JR, Squires RW, Van Iterson EH, Olson TP. Clinical and Rehabilitative Predictors of Peak Oxygen Uptake Following Cardiac Transplantation. J Clin Med 2019; 8:jcm8010119. [PMID: 30669449 PMCID: PMC6352218 DOI: 10.3390/jcm8010119] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/14/2019] [Accepted: 01/16/2019] [Indexed: 12/28/2022] Open
Abstract
The measurement of peak oxygen uptake (VO2peak) is an important metric for evaluating cardiac transplantation (HTx) eligibility. However, it is unclear which factors (e.g., recipient demographics, clinical parameters, cardiac rehabilitation (CR) participation) influence VO2peak following HTx. Consecutive HTx patients with cardiopulmonary exercise testing (CPET) between 2007–2016 were included. VO2peak was measured from CPET standard protocol. Regression analyses determined predictors of the highest post-HTx VO2peak (i.e., quartile 4: VO2peak > 20.1 mL/kg/min). One hundred-forty HTx patients (women: n = 41 (29%), age: 52 ± 12 years, body mass index (BMI): 27 ± 5 kg/m2) were included. History of diabetes (Odds Ratio (OR): 0.17, 95% Confidence Interval (CI): 0.04–0.77, p = 0.021), history of dyslipidemia (OR: 0.42, 95% CI: 0.19–0.93, p = 0.032), BMI (OR: 0.90, 95% CI: 0.82–0.99, p = 0.022), hemoglobin (OR: 1.29, 95% CI: 1.04–1.61, p = 0.020), white blood cell count (OR: 0.81, 95% CI: 0.66–0.98, p = 0.033), CR exercise sessions (OR: 1.10, 95% CI: 1.04–1.15, p < 0.001), and pre-HTx VO2peak (OR: 1.17, 95% CI: 1.07–1.29, p = 0.001) were significant predictors. Multivariate analysis showed CR exercise sessions (OR: 1.10, 95% CI: 1.03–1.16, p = 0.002), and pre-HTx VO2peak (OR: 1.16, 95% CI: 1.04–1.30, p = 0.007) were independently predictive of higher post-HTx VO2peak. Pre-HTx VO2peak and CR exercise sessions are predictive of a greater VO2peak following HTx. These data highlight the importance of CR exercise session attendance and pre-HTx fitness in predicting VO2peak post-HTx.
Collapse
Affiliation(s)
- Katelyn E Uithoven
- School of Kinesiology, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Joshua R Smith
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | - Jose R Medina-Inojosa
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | - Ray W Squires
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | - Erik H Van Iterson
- Section of Preventive Cardiology and Rehabilitation, Cleveland Clinic, Cleveland, OH 44195, USA.
| | - Thomas P Olson
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| |
Collapse
|
11
|
Patel HC, Kaye DM. Exercise training in heart failure: a long way to go yet. Eur J Heart Fail 2018; 20:1744-1745. [DOI: 10.1002/ejhf.1332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/11/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - David M. Kaye
- Baker Heart and Diabetes Institute Melbourne Australia
- Alfred Hospital Melbourne Australia
| |
Collapse
|
12
|
Tucker WJ, Beaudry RI, Samuel TJ, Nelson MD, Halle M, Baggish AL, Haykowsky MJ. Performance Limitations in Heart Transplant Recipients. Exerc Sport Sci Rev 2018; 46:144-151. [DOI: 10.1249/jes.0000000000000149] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
13
|
Yardley M, Gullestad L, Nytrøen K. Importance of physical capacity and the effects of exercise in heart transplant recipients. World J Transplant 2018; 8:1-12. [PMID: 29507857 PMCID: PMC5829450 DOI: 10.5500/wjt.v8.i1.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/12/2017] [Accepted: 12/28/2017] [Indexed: 02/05/2023] Open
Abstract
One of the most important prognostic factors in heart failure patients is physical capacity. Patients with very poor physical performance and otherwise eligible, may be listed as candidates for heart transplantation (HTx). After such surgery, life-long immunosuppression therapy is needed to prevent rejection of the new heart. The dark side of immunosuppression is the increased risk of infections, kidney failure, cancer and advanced atherosclerosis (cardiac allograft vasculopathy), with the two latter conditions as the main causes of later mortality. In a worldwide perspective, 50% of the HTx patients survive past 10 years. Poor aerobic capacity prior to graft deterioration is not only limited to the failing heart, but also caused by peripheral factors, such as limited function in the skeletal muscles and in the blood vessels walls. Exercise rehabilitation after HTx is of major importance in order to improve physical capacity and prognosis. Effects of high-intensity interval training (HIT) in HTx recipients is a growing field of research attracting worldwide focus and interest. Accumulating evidence has shown that HIT is safe and efficient in maintenance HTx recipients; with superior effects on physical capacity compared to conventional moderate exercise. This article generates further evidence to the field by summarizing results from a decade of research performed at our center supported by a broad, but not strict formal, literature review. In short, this article demonstrates a strong association between physical capacity measured after HTx and long-term survival. It describes the possible “HIT-effect” with increased levels of inflammatory mediators of angiogenesis. It also describes long-term effects of HIT; showing a positive effect in development of anxiety symptoms despite that the improved physical capacity was not sustained, due to downregulation of exercise and intensity. Finally, our results are linked to the ongoing HITTS study, which investigates safety and efficiency of HIT in de novo HTx recipients. Together with previous results, this study may have the potential to change existing guidelines and contribute to a better prognosis for the HTx population as a whole.
Collapse
Affiliation(s)
- Marianne Yardley
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo 0424, Norway
- Faculty of Medicine, University of Oslo, Oslo 0316, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo 0424, Norway
- Faculty of Medicine, University of Oslo, Oslo 0316, Norway
| | - Kari Nytrøen
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo 0424, Norway
- Faculty of Medicine, University of Oslo, Oslo 0316, Norway
| |
Collapse
|
14
|
Takakura IT, Hoshi RA, Santos MA, Pivatelli FC, Nóbrega JH, Guedes DL, Nogueira VF, Frota TQ, Castelo GC, Godoy MFD. Recurrence Plots: a New Tool for Quantification of Cardiac Autonomic Nervous System Recovery after Transplant. Braz J Cardiovasc Surg 2017; 32:245-252. [PMID: 28977195 PMCID: PMC5613725 DOI: 10.21470/1678-9741-2016-0035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 02/09/2017] [Indexed: 02/06/2023] Open
Abstract
Objective To evaluate a possible evolutionary post-heart transplant return of autonomic
function using quantitative and qualitative information from recurrence
plots. Methods Using electrocardiography, 102 RR tachograms of 45 patients (64.4% male) who
underwent heart transplantation and that were available in the database were
analyzed at different follow-up periods. The RR tachograms were collected
from patients in the supine position for about 20 minutes. A time series
with 1000 RR intervals was analyzed, a recurrence plot was created, and the
following quantitative variables were evaluated: percentage of determinism,
percentage of recurrence, average diagonal length, Shannon entropy, and
sample entropy, as well as the visual qualitative aspect. Results Quantitative and qualitative signs of heart rate variability recovery were
observed after transplantation. Conclusion There is evidence that autonomic innervation of the heart begins to happen
gradually after transplantation. Quantitative and qualitative analyses of
recurrence can be useful tools for monitoring cardiac transplant patients
and detecting the gradual return of heart rate variability.
Collapse
Affiliation(s)
- Isabela Thomaz Takakura
- Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil.,Universidade de Fortaleza (Unifor), Fortaleza, CE, Brazil
| | - Rosangela Akemi Hoshi
- Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil
| | - Márcio Antonio Santos
- Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Awad M, Czer LSC, Hou M, Golshani SS, Goltche M, De Robertis M, Kittleson M, Patel J, Azarbal B, Kransdorf E, Esmailian F, Trento A, Kobashigawa JA. Early Denervation and Later Reinnervation of the Heart Following Cardiac Transplantation: A Review. J Am Heart Assoc 2016; 5:JAHA.116.004070. [PMID: 27802930 PMCID: PMC5210323 DOI: 10.1161/jaha.116.004070] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Morcos Awad
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Lawrence S C Czer
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Margaret Hou
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sarah S Golshani
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael Goltche
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Michelle Kittleson
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jignesh Patel
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Babak Azarbal
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Evan Kransdorf
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Fardad Esmailian
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Alfredo Trento
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jon A Kobashigawa
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| |
Collapse
|
16
|
Métrich M, Mehmeti F, Feliciano H, Martin D, Regamey J, Tozzi P, Meyer P, Hullin R. Adrenergic Receptor Polymorphism and Maximal Exercise Capacity after Orthotopic Heart Transplantation. PLoS One 2016; 11:e0163475. [PMID: 27669015 PMCID: PMC5036840 DOI: 10.1371/journal.pone.0163475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/10/2016] [Indexed: 11/18/2022] Open
Abstract
Background Maximal exercise capacity after heart transplantion (HTx) is reduced to the 50–70% level of healthy controls when assessed by cardiopulmonary exercise testing (CPET) despite of normal left ventricular function of the donor heart. This study investigates the role of donor heart β1 and β2- adrenergic receptor (AR) polymorphisms for maximal exercise capacity after orthotopic HTx. Methods CPET measured peak VO2 as outcome parameter for maximal exercise in HTx recipients ≥9 months and ≤4 years post-transplant (n = 41; mean peak VO2: 57±15% of predicted value). Donor hearts were genotyped for polymorphisms of the β1-AR (Ser49Gly, Arg389Gly) and the β2-AR (Arg16Gly, Gln27Glu). Circumferential shortening of the left ventricle was measured using magnetic resonance based CSPAMM tagging. Results Peak VO2 was higher in donor hearts expressing the β1-Ser49Ser alleles when compared with β1-Gly49 carriers (60±15% vs. 47±10% of the predicted value; p = 0.015), and by trend in cardiac allografts with the β1-AR Gly389Gly vs. β1-Arg389 (61±15% vs. 54±14%, p = 0.093). Peak VO2 was highest for the haplotype Ser49Ser-Gly389, and decreased progressively for Ser49Ser-Arg389Arg > 49Gly-389Gly > 49Gly-Arg389Arg (adjusted R2 = 0.56, p = 0.003). Peak VO2 was not different for the tested β2-AR polymorphisms. Independent predictors of peak VO2 (adjusted R2 = 0.55) were β1-AR Ser49Gly SNP (p = 0.005), heart rate increase (p = 0.016), and peak systolic blood pressure (p = 0.031). Left ventricular (LV) motion kinetics as measured by cardiac MRI CSPAMM tagging at rest was not different between carriers and non-carriers of the β1-AR Gly49allele. Conclusion Similar LV cardiac motion kinetics at rest in donor hearts carrying either β1-AR Gly49 or β1-Ser49Ser variant suggests exercise-induced desensitization and down-regulation of the β1-AR Gly49 variant as relevant pathomechanism for reduced peak VO2 in β1-AR Gly49 carriers.
Collapse
Affiliation(s)
- Mélanie Métrich
- Cardiology, Cardiovascular Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Fortesa Mehmeti
- Cardiology, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Helene Feliciano
- Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - David Martin
- Cardiology, Cardiovascular Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Julien Regamey
- Cardiology, Cardiovascular Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Piergiorgio Tozzi
- Cardiac Surgery, Cardiovascular Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Philippe Meyer
- Cardiology, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Roger Hullin
- Cardiology, Cardiovascular Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- * E-mail:
| | | |
Collapse
|
17
|
Gayda M, Desjardins A, Lapierre G, Dupuy O, Fraser S, Bherer L, Juneau M, White M, Gremeaux V, Labelle V, Nigam A. Cerebral Hemodynamics During Exercise and Recovery in Heart Transplant Recipients. Can J Cardiol 2016; 32:539-46. [DOI: 10.1016/j.cjca.2015.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/17/2015] [Accepted: 07/17/2015] [Indexed: 11/24/2022] Open
|
18
|
Ciolac EG, Castro RE, Greve JMD, Bacal F, Bocchi EA, Guimarães GV. Prescribing and Regulating Exercise with RPE after Heart Transplant: A Pilot Study. Med Sci Sports Exerc 2016; 47:1321-7. [PMID: 25343537 DOI: 10.1249/mss.0000000000000553] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The objective of this study is to analyze the use of the 6-20 RPE scale for prescribing and self-regulating heated water-based exercise (HEx) and land-based exercise (LEx) in heart transplant recipients. METHODS Fifteen (five females) clinically stable heart transplant recipients (time since surgery = 4.0 ± 2.5 yr) age 46.7 ± 11.8 yr underwent a symptom-limited maximal graded exercise test on a treadmill to determine their HR at anaerobic threshold (HRAT), respiratory compensation point (HRRCP), and maximal effort (HRmax). After a week, patients were randomized to perform 30 min of both HEx (walking inside the pool) and LEx (treadmill walking) sessions at a pace between 11 and 13 on the 6-20 RPE scale and had their HR measured every 4 min. The interval between sessions was 48-72 h. RESULTS No significant differences between sessions were found in the average HR during HEx and LEx. Patients showed a delay in HR increase during both interventions, with the stabilization beginning after 8 min of exercise. Exercise HR was maintained between the HRAT and HRRCP (in the aerobic exercise training zone) for the most part of both HEx (72% of HR measurements) and LEx (66% of HR measurements). Only a few HR measurements stayed below HRAT (HEx = 9%, LEx = 13%) or above HRRCP (HEx = 19%, LEx = 21%) during both exercise sessions. CONCLUSION Exercise HR was maintained in the aerobic exercise training zone (between HRAT and HRRCP) for the most part of both sessions, suggesting that the 6-20 RPE scale may be an efficient tool for prescribing and self-regulating HEx and LEx in heart transplant recipients.
Collapse
Affiliation(s)
- Emmanuel Gomes Ciolac
- 1Exercise and Chronic Disease Research Laboratory, Physical Education Department, School of Sciences, São Paulo State University - UNESP, Bauru, BRAZIL; 2Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, BRAZIL; 3Institute of Orthopedics and Traumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, BRAZIL
| | | | | | | | | | | |
Collapse
|
19
|
Lundgren J, Rådegran G. Hemodynamic Characteristics Including Pulmonary Hypertension at Rest and During Exercise Before and After Heart Transplantation. J Am Heart Assoc 2015. [PMID: 26199230 PMCID: PMC4608067 DOI: 10.1161/jaha.115.001787] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Little is known about the hemodynamic response to exercise in heart failure patients at various ages before and after heart transplantation (HT). This information is important because postoperative hemodynamics may be a predictor of survival. To investigate the hemodynamic response to HT and exercise, we grouped our patients based on preoperative age and examined their hemodynamics at rest and during exercise before and after HT. Methods and Results Ninety-four patients were evaluated at rest prior to HT with right heart catheterization at our laboratory. Of these patients, 32 were evaluated during slight supine exercise before and 1 year after HT. Postoperative evaluations were performed at rest 1 week after HT and at rest and during exercise at 4 weeks, 3 months, 6 months, and 1 year after HT. The exercise patients were divided into 2 groups based on preoperative age of ≤50 or >50 years. There were no age-dependent differences in the preoperative hemodynamic exercise responses. Hemodynamics markedly improved at rest and during exercise at 1 and 4 weeks, respectively, after HT; however, pulmonary and, in particular, ventricular filling pressures remained high during exercise at 1 year after HT, resulting in normalized pulmonary vascular resistance response but deranged total pulmonary vascular resistance response. Conclusions Our findings suggest that, (1) in patients with heart failure age ≤50 or >50 years may not affect the hemodynamic response to exercise to the same extent as in healthy persons, and (2) total pulmonary vascular resistance may be more adequate than pulmonary vascular resistance for evaluating the exercise response after HT.
Collapse
Affiliation(s)
- Jakob Lundgren
- The Haemodynamic Lab, The Section for Heart Failure and Valvular Disease, The Heart and Lung Clinic, Skåne University Hospital, Lund, Sweden (J.L., G.R.) Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden (J.L., G.R.)
| | - Göran Rådegran
- The Haemodynamic Lab, The Section for Heart Failure and Valvular Disease, The Heart and Lung Clinic, Skåne University Hospital, Lund, Sweden (J.L., G.R.) Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden (J.L., G.R.)
| |
Collapse
|
20
|
Pascoalino LN, Ciolac EG, Tavares AC, Castro RE, Ayub-Ferreira SM, Bacal F, Issa VS, Bocchi EA, Guimarães GV. Exercise training improves ambulatory blood pressure but not arterial stiffness in heart transplant recipients. J Heart Lung Transplant 2014; 34:693-700. [PMID: 25662857 DOI: 10.1016/j.healun.2014.11.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 10/30/2014] [Accepted: 11/04/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Hypertension is the most prevalent comorbidity after heart transplantation (HT). Exercise training (ET) is widely recommended as a key non-pharmacologic intervention for the prevention and management of hypertension, but its effects on ambulatory blood pressure (ABP) and some mechanisms involved in the pathophysiology of hypertension have not been studied in this population. The primary purpose of this study was to investigate the effects of ET on ABP and arterial stiffness of HT recipients. METHODS 40 HT patients, randomized to ET (n = 31) or a control group (n = 9) underwent a maximal graded exercise test, 24-hour ABP monitoring, and carotid-femoral pulse wave velocity (PWV) assessment before the intervention and at a 12-week follow-up assessment. The ET program was performed thrice-weekly and consisted primarily of endurance exercise (40 minutes) at ~70% of maximum oxygen uptake (Vo2MAX). RESULTS The ET group had reduced 24-hour (4.0 ± 1.4 mm Hg, p < 0.01) and daytime (4.8 ± 1.6 mm Hg, p < 0.01) systolic ABP, and 24-hour (7.0 ± 1.4 mm Hg, p < 0.001) daytime (7.5 ± 1.6 mm Hg, p < 0.001) and nighttime (5.9 ± 1.5 mm Hg, p < 0.001) diastolic ABP after the intervention. The ET group also had improved Vo2MAX (9.7% ± 2.6%, p < 0.001) after the intervention. However, PWV did not change after ET. No variable was changed in the control group after the intervention. CONCLUSIONS The 12-week ET program was effective for reducing ABP but not PWV in heart transplant recipients. This result suggests that endurance ET may be a tool to counteract hypertension in this high-risk population.
Collapse
Affiliation(s)
- Lucas Nóbilo Pascoalino
- Heart Institute, School of Medicine, University of São Paulo - USP, São Paulo, São Paulo, Brazil
| | - Emmanuel Gomes Ciolac
- Exercise and Chronic Disease Research Laboratory, Physical Education Department, School of Sciences, São Paulo State University - UNESP, Bauru, São Paulo, Brazil.
| | - Aline Cristina Tavares
- Heart Institute, School of Medicine, University of São Paulo - USP, São Paulo, São Paulo, Brazil; Syrian-Lebanese Hospital, São Paulo, São Paulo, Brazil
| | - Rafael Ertner Castro
- Heart Institute, School of Medicine, University of São Paulo - USP, São Paulo, São Paulo, Brazil
| | | | - Fernando Bacal
- Heart Institute, School of Medicine, University of São Paulo - USP, São Paulo, São Paulo, Brazil
| | - Victor Sarli Issa
- Heart Institute, School of Medicine, University of São Paulo - USP, São Paulo, São Paulo, Brazil
| | - Edimar Alcides Bocchi
- Heart Institute, School of Medicine, University of São Paulo - USP, São Paulo, São Paulo, Brazil
| | | |
Collapse
|
21
|
Abstract
Organ transplantation is one of the medical miracles or the 20th century. It has the capacity to substantially improve exercise performance and quality of life in patients who are severely limited with chronic organ failure. We focus on the most commonly performed solid-organ transplants and describe peak exercise performance following recovery from transplantation. Across all of the common transplants, evaluated significant reduction in VO2peak is seen (typically renal and liver 65%-80% with heart and/or lung 50%-60% of predicted). Those with the lowest VO2peak pretransplant have the lowest VO2peak posttransplant. Overall very few patients have a VO2peak in the normal range. Investigation of the cause of the reduction of VO2peak has identified many factors pre- and posttransplant that may contribute. These include organ-specific factors in the otherwise well-functioning allograft (e.g., chronotropic incompetence in heart transplantation) as well as allograft dysfunction itself (e.g., chronic lung allograft dysfunction). However, looking across all transplants, a pattern emerges. A low muscle mass with qualitative change in large exercising skeletal muscle groups is seen pretransplant. Many factor posttransplant aggravate these changes or prevent them recovering, especially calcineurin antagonist drugs which are key immunosuppressing agents. This results in the reduction of VO2peak despite restoration of near normal function of the initially failing organ system. As such organ transplantation has provided an experiment of nature that has focused our attention on an important confounder of chronic organ failure-skeletal muscle dysfunction.
Collapse
Affiliation(s)
- Trevor J Williams
- Department of Allergy, Immunology, and Respiratory Medicine Alfred Hospital and Monash University, Melbourne, Australia.
| | | |
Collapse
|
22
|
Crisafulli A, Tocco F, Milia R, Angius L, Pinna M, Olla S, Roberto S, Marongiu E, Porcu M, Concu A. Progressive improvement in hemodynamic response to muscle metaboreflex in heart transplant recipients. J Appl Physiol (1985) 2012. [PMID: 23195627 DOI: 10.1152/japplphysiol.01099.2012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Exercise capacity remains lower in heart transplant recipients (HTRs) following transplant compared with normal subjects, despite improved cardiac function. Moreover, metaboreceptor activity in the muscle has been reported to increase. The aim of the present investigation was to assess exercise capacity together with metaboreflex activity in HTR patients for 1 yr following heart transplant, to test the hypothesis that recovery in exercise capacity was paralleled by improvements in response to metaboreflex. A cardiopulmonary test for exercise capacity and Vo(2max) and hemodynamic response to metaboreflex activation obtained by postexercise ischemia were gathered in six HTRs and nine healthy controls (CTL) four times: at the beginning of the study (T0, 42 ± 6 days after transplant), at the 3rd, 6th, and 12th month after TO (T1, T2, and T3). The main results were: 1) exercise capacity and Vo(2max) were seen to progressively increase in HTRs; 2) at T0 and T1, HTRs achieved a higher blood pressure response in response to metaboreflex compared with CTL, and this difference disappeared at T2 and T3; and 3) this exaggerated blood pressure response was the result of a systemic vascular resistance increment. This study demonstrates that exercise capacity progressively improves in HTRs after transplant and that this phenomenon is accompanied by a progressive reduction of the metaboreflex-induced increase in blood pressure and systemic vascular resistance. These facts indicate that, despite improved cardiac function, resetting of cardiovascular regulation in HTRs requires months.
Collapse
Affiliation(s)
- Antonio Crisafulli
- Department of Medical Sciences, Sport Physiology Lab., University of Cagliari, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Banks L, Dipchand AI, Manlhiot C, Millar K, McCrindle BW. Factors associated with low physical activity levels following pediatric cardiac transplantation. Pediatr Transplant 2012; 16:716-21. [PMID: 22607632 DOI: 10.1111/j.1399-3046.2012.01706.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Objectively measured MVPA levels following pediatric cardiac transplantation are unknown despite physical health implications. We sought to determine factors associated with MVPA in a pediatric cohort who had undergone cardiac transplantation. METHODS Study assessments included maximal exercise testing (VO(2) max), accelerometry, and physical activity (HAES) and functional health status (CHQ-PF50) questionnaires. RESULTS Participants (n = 20, 60% male, age: 11.8 ± 3.0 yr old) had a VO(2) max of 28.5 ± 6.8 mL/kg/min (%-predicted: 65 ± 14%) and maximal heart rate of 154 ± 16 beats/min (%-predicted: 73 ± 7.5%). Participants performed a median of 7.6 min/day (Q1 4.0 min/day, Q3 11.0 min/day) of MVPA. Each additional year of age at transplantation was associated with a decrease of 1.9 [1.0] min/day of MVPA (p = 0.07). Predicted VO(2) max, maximal power output, male sex, and age at study enrollment were not associated with an increase in MVPA. Parents' perception of their child's functional health status (CHQ-PF50) was lower on general health (p < 0.01) and family activity (p < 0.01) domains relative to a population-based cohort of parents reporting on healthy children. CONCLUSION Pediatric cardiac transplantation recipients may be indicated to participate in cardiac rehabilitation to optimize physical activity levels.
Collapse
Affiliation(s)
- Laura Banks
- Division of Cardiology, Department of Pediatrics, University of Toronto, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | |
Collapse
|
24
|
Vanderlaan RD, Conway J, Manlhiot C, McCrindle BW, Dipchand AI. Enhanced exercise performance and survival associated with evidence of autonomic reinnervation in pediatric heart transplant recipients. Am J Transplant 2012; 12:2157-63. [PMID: 22487123 DOI: 10.1111/j.1600-6143.2012.04046.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Following heart transplantation (HTx), loss of autonomic input to the allograft results in elevated resting heart rate (HR) and decreased chronotropic reserve. As enhanced exercise capacity and HR recovery post exercise are suggestive of reinnervation in pediatric cohorts, we used heart rate variability (HRV) analysis to assess autonomic reinnervation in pediatric HTx recipients. Pediatric patients transplanted between 1996 and 2010 and with serial 24-hour Holter recordings post-HTx were analyzed for HRV using time and frequency domain measures. Of 112 patients, 68 (57%) showed evidence of autonomic reinnervation that was not associated with age at HTx. Evidence of reinnervation was associated with a significant increase in low-frequency power spectrum (p<0.001), suggesting sympathetic reinnervation. Patients with evidence of reinnervation showed higher percent-predicted maxVO(2) on performing an exercise test (+10.2 ± 3.6%, p = 0.006) and improved HR recovery at 3 minutes (-11.4 ± 3.9 bpm, p = 0.004), but no difference in percent-predicted maximal HR. Cox hazards modeling using presumed sinus reinnervation criteria at last Holter recording as a time-dependent covariate was associated with decreased hazard of mortality and/or retransplantation (HR: 0.2, 95% CI 0.04-1.0, p = 0.05). In conclusion, a majority of pediatric HTx recipients demonstrate evidence of reinnervation that is associated with functional outcomes. Studies to assess graft reinnervation as a marker of long-term prognosis are warranted.
Collapse
Affiliation(s)
- R D Vanderlaan
- Labatt Heart Centre, Hospital for Sick Children, Department of Pediatrics, University of Toronto, Ontario, Canada
| | | | | | | | | |
Collapse
|
25
|
Czer LSC, Cohen MH, Gallagher SP, Czer LA, Soukiasian HJ, Rafiei M, Pixton JR, Awad M, Trento A. Exercise performance comparison of bicaval and biatrial orthotopic heart transplant recipients. Transplant Proc 2012; 43:3857-62. [PMID: 22172860 DOI: 10.1016/j.transproceed.2011.08.085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 08/04/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND The standard biatrial technique for orthotopic heart transplantation uses a large atrial anastomosis to connect the donor and recipient atria. A modified technique involves bicaval and pulmonary venous anastomoses and is believed to preserve the anatomic configuration and physiological function of the atria. Bicaval heart transplantation reduces postoperative valvular regurgitation and is associated with a lower incidence of pacemaker insertion. OBJECTIVE The aim of this study was to compare postoperative functional capacity and exercise performance in patients with bicaval and biatrial orthotopic heart transplantation. METHODS Patients were selected for the study if they did not have any of the following: obstructive coronary artery disease (>50% stenosis), severe mitral or tricuspid regurgitation, signs of rejection (grade≥1B-1R) on endomyocardial biopsy during the prior year, respiratory impairment, a permanent pacemaker, orthopedic or muscular impediments, or lived more than 150 miles from the medical center. A total of 27 patients qualified. In 15 patients who received a biatrial heart transplant and 12 patients with a bicaval heart transplant, a stationary bicycle exercise test was performed. Ventilatory gas exchange and maximum oxygen consumption measurements were measured. RESULTS Recipient and donor characteristics, including body surface area, donor/recipient weight mismatch, immunosuppressive regimen, and self-reported weekly exercise activity, did not differ between the biatrial and bicaval groups (P=not significant [NS]). At peak exercise, similar heart rate, workload, oxygen consumption, carbon dioxide production, ventilation, functional capacity, and exercise duration were found between the 2 groups (P=NS). Patients in the biatrial group were studied later than patients in the bicaval group (6.54±0.71 vs 4.68±0.28 years; P<.001). CONCLUSION There were no significant differences in the exercise capacity between patients with biatrial versus bicaval techniques for orthotopic heart transplantation. Factors other than the atrial connection (such as cardiac denervation, immunosuppressive drug effect, or physical deconditioning) may be more important determinants of subnormal exercise capacity after heart transplantation. Nevertheless, the reduction in morbidity and postoperative complications and the simplicity in the bicaval technique suggest that bicaval heart transplantation offers advantages when compared with the standard biatrial technique.
Collapse
Affiliation(s)
- L S C Czer
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Vanhees L, Rauch B, Piepoli M, van Buuren F, Takken T, Börjesson M, Bjarnason-Wehrens B, Doherty P, Dugmore D, Halle M. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular disease (Part III). Eur J Prev Cardiol 2012; 19:1333-56. [DOI: 10.1177/2047487312437063] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - B Rauch
- Centre for Ambulatory Cardiac and Angiologic Rehabilitation, Ludwigshafen, Germany
| | - M Piepoli
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | - T Takken
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Börjesson
- Sahlgrenska University Hospital/Ostra, Goteborg, Sweden
| | | | | | - D Dugmore
- Wellness International Medical Centre, Stockport, UK
| | - M Halle
- University Hospital ‘Klinikum rechts der Isar’, Technische Universitaet Muenchen, Munich, Germany
| | | |
Collapse
|
27
|
Yeung JP, Human DG, Sandor GGS, De Souza AM, Potts JE. Serial measurements of exercise performance in pediatric heart transplant patients using stress echocardiography. Pediatr Transplant 2011; 15:265-71. [PMID: 21492351 DOI: 10.1111/j.1399-3046.2010.01467.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Heart transplantation is an increasingly acceptable therapeutic option for children with end-stage and complex congenital heart disease. With advances in surgery, immunosuppression, and follow-up care, functional outcomes need to be evaluated. We report the results of serial exercise testing performed using stress echocardiography in a cohort of pediatric HTP. HTP (n = 7) exercised on a semi-recumbent ergometer to volitional fatigue. Echocardiography-Doppler measurements, HR, and blood pressure were taken at rest and during staged exercise. Results were compared with healthy CON (n = 12). HTP did significantly less work during exercise (940 vs. 1218 J/kg, p < 0.03). Their SVI (33 vs. 49 mL/m(2), p < 0.003), CI (5.16 vs. 9.25 L/min/m(2), p < 0.0005), and HR (162 vs. 185 bpm, p < 0.02) were lower at peak exercise. HTP had a lower SF at peak exercise (48% vs. 52%, p < 0.03) and an abnormal relationship between the MVCFc and σPS. During follow-up, hemodynamics and left ventricular function remained relatively constant in HTP. HTP are able to exercise safely; however, their exercise tolerance is reduced, and hemodynamics and contractility are diminished. Over time, their hemodynamics and left ventricular function have remained relatively constant.
Collapse
Affiliation(s)
- Joanne P Yeung
- Department of Pediatrics, BC Children's Hospital, The University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | |
Collapse
|
28
|
Chaudry H, Yip DS, Bush T, Reynolds V, Witzke L, Taylor V, Hosenpud JD. Exercise performance increases coincident to body weight over the first two years following cardiac transplantation. Clin Transplant 2011; 25:685-8. [PMID: 21355882 DOI: 10.1111/j.1399-0012.2011.01410.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND To determine whether exercise performance changed over time once patients stabilized after heart transplantation, metabolic stress testing was performed in patients one and two yr post-heart transplantation. METHODS The patient cohort includes those transplanted in our program who survived at least two yr and were able to perform metabolic stress tests during their one- and two-yr annual evaluations. Standard stress test parameters were assessed, including weight, body surface area, rest and exercise heart rate (HR) and blood pressure (BP), exercise time, anaerobic threshold (AT), and maximum VO2 (MVO2). Ejection fraction by echo was also collected. Each patient served as their own control and data were compared using paired t-testing. RESULTS Fifty patients were included in the cohort, 48 of whom were able to exercise to at least AT. Patient weight increased from year 1 to year 2 (82.4 ± 15.1 vs. 85.0 ± 17.0 kg, p = 0.035). Systolic BP increased approximately 40 mmHg with exercise with no change in diastolic BP, and there was no difference between years 1 and 2. HR increased approximately 25 bpm with exercise. There was no difference in resting HR but exercise HR increased significantly between yrs (148 ± 15 bpm vs. 154 ± 18 bpm, p = 0.017). Both VO2 at AT and MVO2 increased significantly from year 1 to year 2 (1116 ± 347 mL/min vs. 1192 ± 313 mL/min, p = 0.049 and 1523 ± 337 mL/min vs. 1599 ± 356 mL/min, p = 0.012, respectively) but when corrected for body weight, there were no differences (VO2-AT 13.6 ± 4.0 mL/kg/min vs. 14.0 ± 4.0 mL/kg/min; MVO2 18.7 ± 4.2 mL/kg/min vs. 18.8 ± 4.1 mL/kg/min). All other measured parameters were not different. There was a weak but statistically significant correlation between change in peak HR and change in VO2 at AT between one and two yr post-transplantation (r = 0.30, p = 0.04). CONCLUSIONS We conclude that exercise performance as measured by VO2 can increase over time post-heart transplantation and in our cohort appears to be related to both an increase in body weight and an increase in HR from years 1 and 2.
Collapse
Affiliation(s)
- Hannah Chaudry
- Department of Transplantation, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | | | | | | | | | | | | |
Collapse
|
29
|
Weiner RB, Weyman AE, Khan AM, Reingold JS, Chen-Tournoux AA, Scherrer-Crosbie M, Picard MH, Wang TJ, Baggish AL. Preload dependency of left ventricular torsion: the impact of normal saline infusion. Circ Cardiovasc Imaging 2010; 3:672-8. [PMID: 20826594 DOI: 10.1161/circimaging.109.932921] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND left ventricular (LV) rotation results from contraction of obliquely oriented myocardial fibers. The net difference between systolic apical counterclockwise rotation and basal clockwise rotation is left ventricular torsion (LVT). Although LVT is altered in various cardiac diseases, determinants of LVT are incompletely understood. METHODS AND RESULTS LV end-diastolic volume, LV apical and basal rotation, peak systolic LVT, and peak early diastolic untwisting rate were measured by speckle-tracking echocardiography in healthy subjects (n=8) before and after infusion of a weight-based normal saline bolus (2.1±0.3 L). Saline infusion led to a significant increase in end-diastolic LV internal diameter (45.9±3.7 versus 47.6±4.2 mm; P=0.002) and LV end-diastolic volume (90.0±21.6 versus 98.3±19.6 mL; P=0.01). Stroke volume (51.3±10.9 versus 63.0±15.5 mL; P=0.003) and cardiac output (3.4±0.8 versus 4.4±1.5 L/min; P=0.007) increased, whereas there was no change in heart rate and blood pressure. There was a significant increase in the magnitude of peak systolic apical rotation (7.5±2.4° versus 10.5±2.8°; P<0.001) but no change in basal rotation (-4.1±2.3° versus -4.8±3.1°; P=0.44). Accordingly, peak systolic LVT increased by 33% after saline infusion (11.2±1.3° versus 14.9±1.7°; P<0.001). This saline-induced increase in LVT was associated with a marked increase in peak early diastolic untwisting rate (72.3±21.4 versus 136.8±30.0 degrees/s; P<0.001). CONCLUSIONS peak systolic LVT and peak early diastolic untwisting rate are preload-dependent. Changes in LV preload should be considered when interpreting results of future LVT studies.
Collapse
Affiliation(s)
- Rory B Weiner
- Division of Cardiology, Massachusetts General Hospital, Boston, Mass., USA
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Standards for the use of cardiopulmonary exercise testing for the functional evaluation of cardiac patients: a report from the Exercise Physiology Section of the European Association for Cardiovascular Prevention and Rehabilitation. ACTA ACUST UNITED AC 2009; 16:249-67. [PMID: 19440156 DOI: 10.1097/hjr.0b013e32832914c8] [Citation(s) in RCA: 250] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Cardiopulmonary exercise testing (CPET) is a methodology that has profoundly affected the approach to patients' functional evaluation, linking performance and physiological parameters to the underlying metabolic substratum and providing highly reproducible exercise capacity descriptors. This study provides professionals with an up-to-date review of the rationale sustaining the use of CPET for functional evaluation of cardiac patients in both the clinical and research settings, describing parameters obtainable either from ramp incremental or step constant-power CPET and illustrating the wealth of information obtainable through an experienced use of this powerful tool. The choice of parameters to be measured will depend on the specific goals of functional evaluation in the individual patient, namely, exercise tolerance assessment, training prescription, treatment efficacy evaluation, and/or investigation of exercise-induced adaptations of the oxygen transport/utilization system. The full potentialities of CPET in the clinical and research setting still remain largely underused and strong efforts are recommended to promote a more widespread use of CPET in the functional evaluation of cardiac patients.
Collapse
|
31
|
Ethics of cardiac transplantation in hypoplastic left heart syndrome. Pediatr Cardiol 2009; 30:725-8. [PMID: 19396387 PMCID: PMC2715463 DOI: 10.1007/s00246-009-9428-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 01/21/2009] [Accepted: 03/11/2009] [Indexed: 11/03/2022]
|
32
|
Exercise Capacity Improves With Time in Pediatric Heart Transplant Recipients. J Heart Lung Transplant 2009; 28:585-90. [DOI: 10.1016/j.healun.2009.01.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 01/12/2009] [Accepted: 01/21/2009] [Indexed: 11/20/2022] Open
|
33
|
Van Laethem C, Bartunek J, Goethals M, Verstreken S, Walravens M, De Proft M, Keppens C, Calders P, Vanderheyden M. Chronic Kidney Disease is Associated With Decreased Exercise Capacity and Impaired Ventilatory Efficiency in Heart Transplantation Patients. J Heart Lung Transplant 2009; 28:446-52. [DOI: 10.1016/j.healun.2009.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Revised: 01/07/2009] [Accepted: 01/21/2009] [Indexed: 01/09/2023] Open
|
34
|
Zhang R, Haverich A, Strüber M, Simon A, Pichlmaier M, Bara C. Effects of ivabradine on allograft function and exercise performance in heart transplant recipients with permanent sinus tachycardia. Clin Res Cardiol 2008; 97:811-9. [PMID: 18648727 DOI: 10.1007/s00392-008-0690-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2007] [Accepted: 06/11/2008] [Indexed: 12/22/2022]
Abstract
Aim of this retrospective analysis was to evaluate the effects of ivabradine given primarily as a heart rate-lowering agent on allograft function and cardiopulmonary performance in heart transplant recipients with permanent sinus tachycardia. Starting May 2006, 26 heart transplant recipients with permanent sinus tachycardia received ivabradine (5 mg bid). It was discontinued early in 3 patients (11.5%) due to adverse events. In the remaining 23 patients, resting heart rate (HR) was significantly lowered from 106.3 +/- 9.1 to 82.2 +/- 6.3 bpm after 3 weeks of treatment. The effect remained constant during the remaining treatment period, whereas resting blood pressure was not affected. After 12 weeks of ivabradine treatment, the corrected QT interval was significantly reduced into the range seen in normal individuals. Left ventricular (LV) end-diastolic posterior wall thickness, LV mass and LV mass index were also found to have decreased significantly. There was a trend to improvement of cardiopulmonary performance and LV ejection fraction, both of which did not reach statistical significance, however. It may be concluded that ivabradine successfully reduced the resting HR of heart transplant recipients with sinus tachycardia without negatively influencing the blood pressure. The definitive impact of ivabradine on LV mass regression and cardiopulmonary performance require further prospective, randomized and controlled trials.
Collapse
Affiliation(s)
- R Zhang
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | | | | | | | | | | |
Collapse
|
35
|
Effects of exercise training on forearm and calf vasodilation and proinflammatory markers in recent heart transplant recipients: a pilot study. ACTA ACUST UNITED AC 2008; 15:10-8. [PMID: 18277180 DOI: 10.1097/hjr.0b013e3282f0b63b] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Aerobic exercise training improves vasodilatory capacity of peripheral resistance vasculature and modifies plasma proinflammatory markers in chronic heart failure patients. It is, however, currently unknown whether aerobic exercise has a similar effect in heart transplant recipients (HTR). DESIGN AND METHODS Eight weeks after transplantation, 14 HTR were randomly assigned to 12 weeks of supervised aerobic exercise training (TRAINED; n=8) or attention-time control (CONTROL; n=6) in addition to posttransplantation medical care. Peak forearm blood flow and calf blood flow (CBF) during reactive hyperemia after 5 min of limb ischemia was used as a measure of endothelium-dependent vasodilation of limb resistance arteries. Plasma C-reactive protein, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), soluble intercellular adhesion molecule-1 (sICAM-1), and exercise capacity were measured at baseline and again after 12 weeks in both groups. RESULTS Peak CBF increased 22% in the TRAINED (25.9+/-5.8-31.6+/-7.9 ml/min/100 ml, P<0.05), but there was no change in peak CBF after 12 weeks in CONTROL. Plasma C-reactive protein, IL-6, TNF-alpha, sICAM-1 did not change in TRAINED, but there was a significant increase in TNF-alpha (1.66+/-1.02 vs. 3.07+/-1.10 pg/ml, P<0.05), and sICAM-1 (205.9+/-59.1 vs. 245.0+/-47.9 ng/ml, P<0.01) in CONTROL after 12 weeks. Furthermore, exercise test duration improved 51.7% (P<0.01) and there was a trend toward an increase in peak VO2 (P=0.05) in TRAINED after 12 weeks but neither changed in CONTROL. CONCLUSION A program of supervised aerobic exercise improves endothelium-dependent vasodilation of the calf, but not forearm resistance arteries, and may attenuate a progressive increase in selected proinflammatory markers in HTR.
Collapse
|
36
|
Rebuttal from Dr. Andreassen. J Appl Physiol (1985) 2008. [DOI: 10.1152/japplphysiol.00694.2007b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
37
|
Andreassen AK. Point:Counterpoint: Cardiac denervation does/does not play a major role in exercise limitation after heart transplantation. J Appl Physiol (1985) 2008; 104:559-60. [PMID: 17615275 DOI: 10.1152/japplphysiol.00694.2007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Arne K Andreassen
- Department of Cardiology, Rikshospitalet-Radiumhospitalet Medical Center, University of Oslo, Oslo, Norway.
| |
Collapse
|
38
|
Fava M, Meneses L, Loyola S, Castro P, Barahona F. TIPSS procedure in the treatment of a single patient after recent heart transplantation because of refractory ascites due to cardiac cirrhosis. Cardiovasc Intervent Radiol 2007; 31 Suppl 2:S188-91. [PMID: 18071789 DOI: 10.1007/s00270-007-9251-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Revised: 10/30/2007] [Accepted: 11/15/2007] [Indexed: 11/26/2022]
Abstract
We present the case of a female patient with arrhythmogenic dysplasia of the right ventricle who evolved to refractory heart failure, ascites, and peripheral edema. As a result, heart transplantation was performed. Subsequently, refractory ascites impaired the patient's respiratory function, resulting in prolonged mechanical ventilation. She was successfully treated with transjugular intrahepatic portosystemic shunt (TIPSS) placement, which allowed satisfactory weaning of ventilatory support.
Collapse
Affiliation(s)
- Mario Fava
- Radiology Department, Hospital Clínico Universidad Católica de Chile, Marcoleta 367, Santiago, Chile
| | | | | | | | | |
Collapse
|
39
|
Longitudinal Changes in Heart Rate Recovery After Maximal Exercise in Pediatric Heart Transplant Recipients: Evidence of Autonomic Re-innervation? J Heart Lung Transplant 2007; 26:1306-12. [DOI: 10.1016/j.healun.2007.08.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Revised: 08/29/2007] [Accepted: 08/29/2007] [Indexed: 11/19/2022] Open
|
40
|
Heart Rate Reduction After Heart Transplantation With Beta-Blocker Versus the Selective If Channel Antagonist Ivabradine. Transplantation 2007; 84:988-96. [DOI: 10.1097/01.tp.0000285265.86954.80] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
41
|
Patterson JA, Pitetti KH, Young KC, Goodman WF, Farhoud H. Case Report on PWC of a Competitive Cyclist before and after Heart Transplant. Med Sci Sports Exerc 2007; 39:1447-51. [PMID: 17805072 DOI: 10.1249/mss.0b013e318074d3d7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION It has been well documented that for heart transplant recipients (HTR), posttransplantation physical work capacity (PWC) normally does not exceed 60% of the value for healthy age-matched controls. Few, if any, studies have undertaken posttransplantation PWC measurements of well-conditioned individuals (i.e., PWC>300 W). CASE SUMMARY A 37-yr-old professionally trained male cyclist suffered an acute myocardial infarction (AMI) immediately after a road race and received a heart transplant (HT) 4 months after the AMI. The participant resumed training 1 month after surgery and underwent a maximal exercise test 6 months after surgery. Peak PWC (33.8 mL.kg(-1).min(-1), 250 W) was 92% of the age-predicted maximum, and peak heart rate (165 bpm) was 96% of his known maximum. These results were similar to the participants in a study who had been training regularly for 36+/-24 months before testing, and PWC evaluations occurred 43+/-12 months after HT. CONCLUSION Results suggest that 1) lifestyle before HT may positively affect posttransplantation PWC, 2) exercise capacity was not limited by chronotropic incompetence, and 3) a more aggressive approach to HT recovery could be applied to HTR with similar activity histories.
Collapse
Affiliation(s)
- Jeremy A Patterson
- Department of Kinesiology and Sports Studies, Wichita State University, and Cyprus Heart, Wichita, KS 67260-0016, USA.
| | | | | | | | | |
Collapse
|
42
|
Abstract
PURPOSE Although heart transplantation (HT) increases survival of heart failure patients, many patients still experience problems afterward that affect functioning. PURPOSES (1) to compare the functional status of HT patients before transplant versus 1 year after transplant, (2) to identify functional problems 1 year post-transplant, and (3) to identify which variables predicted worse functional status 1 year later. METHODS The sample was 237 adult HT recipients who completed the 1-year post-transplant study booklet. Functional ability was assessed by the Sickness Impact Profile. Paired t tests compared Sickness Impact Profile scores before and after transplant. Medical and demographic data plus patient questionnaire data on Sickness Impact Profile, symptoms, stressors, and compliance were used in the regression. RESULTS Sickness Impact Profile functional scores improved significantly from pre-transplant (23.0%) to post-transplant (13.4%); however, many HT recipients still reported problems in 12 functional areas 1 year after surgery. Major problem areas were the following: work (90% of patients), eating (due to dietary restrictions, 87%), social interaction (70%), recreation (63%), home management (62%), and ambulation (54%). Only 26% were working 1 year after transplant; 59% of those working reported health-related problems performing their job. Predictors of worse functional status were greater symptom distress, more stressors, more neurologic problems, depression, female sex, older age, and lower left ventricular ejection fraction (worse cardiac function). CONCLUSIONS Many HT recipients were still having functional problems and had not reached their full rehabilitation potential by the 1-year anniversary after transplant.
Collapse
|
43
|
Pierce GL, Magyari PM, Aranda JM, Edwards DG, Hamlin SA, Hill JA, Braith RW. Effect of heart transplantation on skeletal muscle metabolic enzyme reserve and fiber type in end-stage heart failure patients. Clin Transplant 2007; 21:94-100. [PMID: 17302597 DOI: 10.1111/j.1399-0012.2006.00589.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Skeletal muscle myopathy is a hallmark of chronic heart failure (HF). Phenotypic changes involve shift in myosin heavy chain (MHC) fiber type from oxidative, MHC type I, towards more glycolytic MHC IIx fibers, reductions in oxidative enzyme activity, and increase in glycolytic enzyme activity. However, it is unknown if muscle myopathy is reversed following heart transplantation. The purpose of this study was to determine the effect of heart transplantation on skeletal muscle metabolic enzyme reserve and MHC fiber type in end-stage HF patients. METHODS Thirteen HF subjects were prospectively studied before and two months after heart transplantation and a subgroup (n = 6) at eight months after transplantation. Skeletal muscle biopsy of the vastus lateralis was performed and relative MHC composition was determined using sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Lactate dehydrogenase (LDH), citrate synthase (CS), and 3-hydroxyacyl-CoA-dehydrogenase (HACoA) enzyme activity assays were performed to assess glycolytic, oxidative, and beta-oxidative metabolic enzyme reserves, respectively. RESULTS Lactate dehydrogenase activity (130.5 +/- 13.3 vs. 106.1 +/- 13.2 micromol/g wet wt/min, p < 0.05), CS activity (14.0 +/- 1.2 vs. 9 +/- 0.9 micromol/g wet wt/min, p < 0.05), and HACoA activity (4.5 +/- 0.48 vs. 3.6 +/- 0.3 micromol/g wet wt/min, p < 0.05) decreased two months after heart transplantation. At eight months, LDH activity was restored (139.0 +/- 11 micromol/g wet wt/min), but not CS or HACoA activity compared with before transplantation. There was no significant change in muscle %MHC type I (28.7 +/- 3.5% vs. 25.3 +/- 3.0%, p = NS), %MHC type IIa (33.2 +/- 2.0% vs. 34.6 +/- 1.9%, p = NS), or %MHC type IIx (38.1 +/- 2.8% vs. 40.1 +/- 3.7%, p = NS) fiber type two months after heart transplantation. However, %MHC type I (19.3 +/- 6.6%) was decreased and %MHC type IIx (51.0 +/- 6.5%) was increased at eight months after (p < 0.05) compared with before transplantation. CONCLUSIONS Skeletal muscle glycolytic, oxidative, and beta-oxidative enzymatic reserves are diminished early after heart transplantation, with reduced oxidative capacity persisting late in the first year. The myopathic MHC phenotype present in end-stage HF persists early in the post-operative state and declines further by eight months.
Collapse
Affiliation(s)
- Gary L Pierce
- Department of Applied Physiology and Kinesiology, Center for Exercise Science, College of Health and Human Performance, University of Florida, Gainesville, FL, USA.
| | | | | | | | | | | | | |
Collapse
|
44
|
Carter R, Al-Rawas OA, Stevenson A, Mcdonagh T, Stevenson RD. Exercise responses following heart transplantation: 5 year follow-up. Scott Med J 2006; 51:6-14. [PMID: 16910044 DOI: 10.1258/rsmsmj.51.3.6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Heart transplantation is an established treatment for end stage heart failure. In addition to increased life expectancy, heart transplant recipients report a remarkable improvement in symptoms and functional capacity. Exercise performance following heart transplantation, however, remains impaired even in the absence of exertional symptoms. We have assessed the response to exercise in 47 patients with cardiac failure prior to and then at yearly intervals to five years post transplantation. All patients performed incremental symptom limited exercise tests during which minute ventilation (V'E), oxygen consumption (V'O2) and carbon dioxide production (V'CO2) and heart rate (HR) were measured. Ventilatory response (V'E/V'CO2), anaerobic threshold (V'O2 AT %predicted) and heart rate response (HR/VO2) were calculated. The dead space to tidal volume ratio (VD/VT) and alveolar-arterial oxygen gradient (A-aO2) were computed from transcutaneous monitoring. Despite substantial improvement in subjective functional capacity, heart transplant recipients continue to have limited exercise performance [Maximal V'O2% predicted pre-transplant 41.3 (2.2); 1 year 48.6 (1.7), p <0.001: V'O2 AT% 31.5 (1.1); 1 year 35.6 (1.0); respectively p<0.05]. The maximal oxygen uptake continued to improve at two years post-transplant but, thereafter, there was no further significant change at up to 5 years post transplant [50.9 (1.5)]. At one year post-transplantation peak HR [65.2 (0.9) vs 79.1(1.4)] and the HR/VO2 response [24.0(1.8) vs 79.6(4.2)] were significantly reduced compared to pre-transplant values. The heart rate response remained lower compared to predicted at 5 years post-transplant although there was a significant increase compared to one year post-transplant (32.9 vs 24.0mls/bt). There was a weak but significant relationship between maximal VO2 and peak HR (0.39, p<0.05) and HR/VO2 (r= 0.37, p<0.05) at one year post-transplant. Prior to transplantation the ventilatory response to exercise was elevated [V'E/V'CO2 45.6 (2.5)] and decreased significantly following transplantation [1 yr 34.1 (1.3), respectively p<0.001]. In addition, despite significant improvement in VD/VT after transplantation, it remained higher than normal [Pre VD/VT at maximum exercise 0.35 (0.02); 1 yr 0.31 (0.02); p<0.05]. There was a further fall in the VE/VCO2 and VD/VT at two years post-transplantation with no further change at up to 5 years post transplantation [VE/VCO2 32.0 (1.0); VD/VT 0.29 (0.01)]. Although cardiac output is markedly improved after transplantation, due to chronotropic incompetence associated with denervation, its response remains subnormal and this may explain the residual abnormalities of ventilatory and gas exchange responses to exercise following transplantation.
Collapse
Affiliation(s)
- R Carter
- Department of Respiratory Medicine, Glasgow Royal Infirmary
| | | | | | | | | |
Collapse
|
45
|
Effects of physical training on cardiovascular control after heart transplantation. Int J Cardiol 2006; 118:356-62. [PMID: 17050012 DOI: 10.1016/j.ijcard.2006.07.032] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Accepted: 07/11/2006] [Indexed: 12/14/2022]
Abstract
BACKGROUND Exercise performance in heart-transplanted patients increases with respect to pre-transplantation but remains subnormal, and it does not improve with time after surgery. Possible causes include persisting denervation, and sympathetic vasoconstriction inducing functional vascular abnormalities that prevent adequate increase in blood flow to the exercising limbs. We tested the effects of physical training on baroreceptors-mediated control of heart rate and blood pressure in recently heart-transplanted subjects. METHODS Patients were randomly allocated to physical training (n=13, 30 min cycling at 60-70% of peak oxygen consumption for 5 days/week for 6 months) or to control (n=11). Upright exercise test to exhaustion was performed at the beginning of the study after 3 and 6 months. Reflex changes in RR interval and blood pressure in response to sinusoidal neck suction (6 and 12 cycles/min 0 to -30 mm Hg swing) were considered as evidence of reinnervation and baroreflex control of blood pressure, respectively. RESULTS After 6 months peak oxygen consumption (p<0.001), exercise time (p<0.01) and workload (p<0.01) increased in trained patients. Before training RR interval and blood pressure were not modified by neck suction. After physical training systolic (p<0.01) and diastolic blood pressure decreased, RR interval and blood pressure could be modulated (p<0.05) by slow (6 cycles/min) neck suction, indicating initial cardiac sympathetic reinnervation and restored sensitivity to autonomic modulation on the arteries. No changes were observed in controls. CONCLUSIONS Physical training improved exercise performance and the control exerted by the autonomic nervous system through the sympathetic nerves at both cardiac and vascular level.
Collapse
|
46
|
Changes in exercise capacity, ventilation, and body weight following heart transplantation. Eur J Heart Fail 2006; 9:310-6. [PMID: 17023206 DOI: 10.1016/j.ejheart.2006.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Revised: 05/23/2006] [Accepted: 07/07/2006] [Indexed: 12/21/2022] Open
Abstract
AIMS Peak oxygen uptake adjusted to body weight (peak VO(2)) and ventilatory efficiency (VE/VCO(2)-slope) are important prognostic parameters in chronic heart failure. Our study prospectively examined changes in these parameters over 24 months following heart transplantation (HTx) and evaluated the potentially confounding effects of weight gain. METHODS AND RESULTS One hundred patients with chronic heart failure (16 female, mean age at HTx 53.9+/-9.6 years) underwent cardiopulmonary exercise testing before and 3, 6, 12 and/or 24 months after HTx. Twenty-five healthy individuals served as matched normals. VE/VCO(2)-slope during exercise improved significantly at 6 (-23.7%), 12 (-21.3%), and 24 months (-32.3%; all p<0.002 vs. baseline). At 6 months, VE/VCO(2)-slopes were similar to the matched normals (31.8+/-4.3), 46 of 78 patients achieved values within the 95% confidence interval of normal. Peak VO(2) increased significantly after HTx at 6 (+31.8%), 12 (+36.2%), and 24 months (+42.2%; all p<0.005). None of the patients reached values within the 95% CI of normal. Although VE/VCO(2)-slope and peak VO(2) were correlated inversely at every time point (p<0.03), reduction in VE/VCO(2)-slope did not correlate with increase in peak VO(2). Symptoms that limited exercise changed from dyspnoea before HTx to leg fatigue after HTx. CONCLUSION Following HTX, VE/VCO(2)-slope returns to normal values in the majority of patients; however, despite improvement, peak VO(2) remains abnormal in all patients. Symptoms causing patients to stop exercising change from dyspnoea to leg fatigue.
Collapse
|
47
|
Lanfranconi F, Borrelli E, Ferri A, Porcelli S, Maccherini M, Chiavarelli M, Grassi B. Noninvasive Evaluation of Skeletal Muscle Oxidative Metabolism after Heart Transplant. Med Sci Sports Exerc 2006; 38:1374-83. [PMID: 16888448 DOI: 10.1249/01.mss.0000228943.62776.69] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The main aim of the present study was to investigate skeletal muscle oxidative metabolism in heart transplant recipients (HTR) by noninvasive tools. METHODS Twenty male HTR (age 50.4 +/- 2.6 yr; mean +/- SE) and 17 healthy untrained age-matched controls (CTRL) performed an incremental exercise (IE) and a series of constant-load (CLE) moderate-intensity exercise tests on a cycloergometer. The following variables were determined: heart rate (HR); breath-by-breath pulmonary O2 uptake (VO2); and skeletal muscle (vastus lateralis) oxygenation indices by continuous-wave near-infrared spectroscopy. Changes in concentration of deoxygenated hemoglobin (Hb) and myoglobin (Mb) (Delta[deoxy(Hb + Mb)]), expressed as a fraction of values obtained during a transient limb ischemia, were taken as an index of skeletal muscle O2 extraction. "Peak" values were determined at exhaustion during IE. Kinetics of adjustment of variables were determined during CLE. RESULTS VO2peak, HRpeak, and Delta[deoxy(Hb + Mb)] peak were significantly lower in HTR than in CTRL (17.1 +/- 0.7 vs 34.0 +/- 1.9 mL.kg(-1).min(-1), 133.8 +/- 3.8 vs 173.0 +/- 4.8 bpm, and 0.42 +/- 0.03 vs 0.58 +/- 0.04, respectively). In HTR, Delta[deoxy(Hb + Mb)] increase at submaximal workloads was steeper than in CTRL, suggesting an impaired O2 delivery to skeletal muscles, whereas the lower Delta[deoxy(Hb + Mb)] peak values suggest an impaired capacity of O2 extraction at peak exercise. VO2 and HR kinetics during CLE were significantly slower in HTR than in CTRL, whereas, unexpectedly, no significant differences were found for Delta[deoxy(Hb+Mb)] kinetics (mean response time: 21.3 +/- 1.1 vs 20.2 +/- 1.2 s). CONCLUSION The findings confirm the presence of both "central" (cardiovascular) and "peripheral" (at the skeletal muscle level) impairments to oxidative metabolism in HTR. The noninvasiveness of the measurements will allow for serial evaluation of the patients, in the presence and/or absence of rehabilitation programs.
Collapse
Affiliation(s)
- Francesca Lanfranconi
- Department of Science and Biomedical Technologies, University of Milan, Milan, Italy
| | | | | | | | | | | | | |
Collapse
|
48
|
Tabet JY, Meurin P, Ben Driss A, Weber H, Renaud N, Cohen-Solal A. [Exercise training in cardiac patients: usefulness of the cardiopulmonary exercise test]. Ann Cardiol Angeiol (Paris) 2006; 55:178-86. [PMID: 16922166 DOI: 10.1016/j.ancard.2006.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Exercise training is currently including in the treatment of coronary arterial disease patients, in patients with left ventricular dysfunction as well as in patients who underwent cardiac transplantation or cardiac surgery. However methods of prescribing exercise-training programs are difficult to determine and must be adapted for each patient Exercise test with gas analysis through the determination of anaerobic threshold may help to understand the physiopathological mechanism related to exercise limitation in these patients. Exercise test may help to precise exercise intensity during cardiac rehabilitation and may assess the benefits on exercise tolerance.
Collapse
Affiliation(s)
- J Y Tabet
- Service de cardiologie, centre de réadaptation cardiovasculaire de la Brie, 27, rue Sainte-Christine, 77174 Villeneuve-Saint-Denis, France.
| | | | | | | | | | | |
Collapse
|
49
|
Abstract
The study of patient healthcare outcomes after cardiothoracic transplantation has increased substantially over the last 2 decades. Physical function after heart, lung, and heart-lung transplantation has been studied using both subjective and objective measures. The majority of reports in the literature on physical function after cardiothoracic transplantation are descriptive and observational. The purposes of the article are to review and critique the existing literature on cardiothoracic recipients' subjective and objective physical function, including respiratory function for heart-lung and lung transplant recipients. In addition, the literature on sexual function in cardiothoracic recipients is examined, the gaps in the literature are identified, and recommendations are given for future research.
Collapse
Affiliation(s)
- Kathleen L Grady
- Center for Heart Failure, and Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, 201 E. Huron Street, Chicago, IL 60611, USA.
| | | |
Collapse
|
50
|
Kon AA. Discussing Nonsurgical Care With Parents of Newborns With Hypoplastic Left Heart Syndrome. ACTA ACUST UNITED AC 2005. [DOI: 10.1053/j.nainr.2005.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|