Despite improvements in the diagnostic process, therapeutic strategies made little progress in addition to the consolidation of practices supported by limited evidences. Novel complement inhibitors appear promising in changing this scenario. Nevertheless, collaborative multicenter studies are needed to develop standardized approaches tailored to the highly variable clinical and laboratory features of AMR.
a b s t r a c tObjectives: The objectives of this study were to: (1) explore the proportion of HTx centers that have a multidisciplinary team and (2) assess the relationship between multidisciplinarity and the level of chronic illness management (CIM). Background: The International Society for Heart and Lung Transplantation (ISHLT) recommends a multidisciplinary approach in heart transplant (HTx) follow-up care but little is known regarding the proportion of HTx centers that meet this recommendation and the impact on patient care. HTx centers
Aerobic exercise prescription is often set at specific heart rate (HR) values. Previous studies demonstrated that during exercise carried out at a HR slightly above that corresponding to the gas exchange threshold (GET), work rate (WR) has to decrease in order to maintain HR constant. We hypothesized a greater WR decrease at a fixed HR following simulated microgravity/inactivity (bed rest, BR). Ten male volunteers (23±5 yr) were tested before (PRE) and after (POST) a 10-day horizontal BR, and performed on a cycle ergometer: a) incremental exercise; b) 15-min HRCLAMPED exercise, in which WR was continuously adjusted to maintain a constant HR, corresponding to that at 120% of GET determined in PRE; c) two moderate-intensity constant WR (MOD) exercises. Breath-by-breath VO2, HR and other variables were determined. After BR, VO2peak and GET significantly decreased, by about 10%. During HRCLAMPED (145±11 b∙min-1), the decrease in WR needed to maintain a constant HR was greater in POST vs. PRE (-39±10 vs. -29±14%, p<0.01). In 6 subjects the decreased WR switched from the heavy- to the moderate-intensity domain. The decrease in WR during HRCLAMPED, in PRE vs. POST, was significantly correlated with the VO2peak decrease (R2=0.52; p=0.02). A greater amplitude of the slow component of the HR kinetics was observed during MOD following BR. Exercise at a fixed HR is not associated with a specific WR or WR domain; the problem, affecting exercise evaluation and prescription, is greater following BR. The WR decrease during HRCLAMPED is a biomarker of exercise intolerance following BR.
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