Chronotropic Incompetence and Abnormal Heart Rate Recovery Early after Left Ventricular Assist Device Implantation

Dimopoulos, Stavros; Διάκος, Νικόλαος; Tseliou, Eleni; Tasoulis, Athanasios; Mpouchla, Anthi; Manetos, Christos; Katsaros, Lambros; Drakos, Stavros G.; Terrovitis, John; Nanas, Serafim

doi:10.1111/j.1540-8159.2011.03215.x

Cited by 40 publications

(29 citation statements)

References 41 publications

(57 reference statements)

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“…At maximum load, a mean RER of 1.11 (60.07) and a mean lactate concentration of 3.82 (61.0) mmol/L could be measured. Similarly high levels were attained in comparable studies (RER between 1.07 and 1.26 [10,13,[38][39][40]). As the peak exertion level criterion for CPET in healthy subjects, Kroidl et al (16) recommend an RER of >1.11 and an RER of >1.05 in cardiac patients.…”

supporting

confidence: 61%

“…Table 4 summarizes the results of comparable studies which conducted a CPET shortly after LVAD implantation (90 days). In most investigations, comparably low values were recorded (10,13,25,38,39,41 remained unchanged over time at the same (low) levels (12.66 mL/kg/min after 3-6 months, 10.74 mL/kg/min after 1 year, and 11.18 mL/kg/min after more than 1 year). For comparison, patients after heart transplantation usually reach average values of 17-20 mL/kg/min (60-70% of predicted values) in the long term (45).…”

Section: Cardiopulmonary Exercise Capacitymentioning

confidence: 88%

mentioning

confidence: 95%

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Exercise Capacity and Functional Performance in Heart Failure Patients Supported by a Left Ventricular Assist Device at Discharge From Inpatient Rehabilitation

et al. 2017

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Adequate physical and functional performance is an important prerequisite for renewed participation and integration in self-determined private and (where appropriate) professional lives following left ventricular assist device (LVAD) implantation. During cardiac rehabilitation (CR), individually adapted exercise programs aim to increase exercise capacity and functional performance. A retrospective analysis of cardiopulmonary exercise capacity and functional performance in LVAD patients at discharge from a cardiac rehabilitation program was conducted. The results from 68 LVAD patients (59 males, 9 females; 55.9 6 11.7 years; 47 HVAD, 2 MVAD, 15 HeartMate II, 4 HeartMate 3, and 4 different implanting centers) were included in the analysis. Exercise capacity was assessed using a cardiopulmonary exercise test on a bicycle ergometer (ramp protocol; 10 W/min). The 6-min walk test was used to determine functional performance. At discharge from CR (53 6 17 days after implantation), the mean peak work load achieved was 62.2 6 19.3 W (38% of predicted values) or 0.79 6 0.25 W/kg body weight. The mean cardiopulmonary exercise capacity (relative peak oxygen uptake) was 10.6 6 5.3 mL/kg/min (37% of predicted values). The 6-min walk distance improved significantly during CR (325 6 106 to 405 6 77 m; P < 0.01). No adverse events were documented during CR. The results show that, even following LVAD implantation, cardiopulmonary exercise capacity remains considerably restricted. In contrast, functional performance, measured by the 6-min walk distance, reaches an acceptable level. Light everyday tasks seem to be realistically surmountable for patients, making discharge from inpatient rehabilitation possible. Long-term monitoring is required in order to evaluate the situation and how it develops further. Key Words: Heart failure-Left ventricular assist deviceCardiac rehabilitation-Exercise capacity-Functional performance.In the last few years, left ventricular assist devices (LVADs) have been increasingly implanted as treatment for terminal heart failure (HF). Whereas initially these systems were only used as a bridge to transplantation (BTT), today approximately half of all recipients have them implanted as the ultimate destination therapy (DT) (1).The overriding therapeutic goal of LVAD implantation is to ensure patient survival and guarantee preservation of organ function (2). However, when patients become permanently dependent on the system, a return to everyday life and restoration of an acceptable quality of life acquire crucial significance. An optimum build-up of exercise capacity and adequate functional performance is therefore very significant. Cardiac rehabilitation (CR) can and should make an important contribution in this context (3,4). After being discharged from a CR center the patients should once more become able to autonomously manage the necessary tasks in their everyday lives back home.Over the last few years, several studies have emerged, most of them small, which report results following rehabilitat...

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supporting

confidence: 61%

Section: Cardiopulmonary Exercise Capacitymentioning

confidence: 88%

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Exercise Capacity and Functional Performance in Heart Failure Patients Supported by a Left Ventricular Assist Device at Discharge From Inpatient Rehabilitation

et al. 2017

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“…Patients are also seen to have impaired chronotropic reserve and an abnormal heart rate recovery early after continuous-flow LVAD placement, indicating significant cardiac autonomic abnormalities. 11 However, improvement in cardiac sympathetic innervation is noted after LVAD placement in long-term follow-up, suggesting recovery of autonomic function. 12 Under ideal conditions, unloading the LV usually improves systemic hemodynamics but in doing so may have detrimental effects on the RV.…”

Section: Discussionmentioning

confidence: 97%

Recurrent orthostatic syncope due to left atrial and left ventricular collapse after a continuous-flow left ventricular assist device implantation

Chandra

Pradhan

Kim

et al. 2013

The Journal of Heart and Lung Transplantation

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“…[16][17][18] Two small studies with paired pre-and postimplant VO 2 showed similarly small increases in VO 2 max after 3-6 months of support. 19,20 Recently, Nahumi et al 21 2.0 ± 0.7 Mixed venous oxygen saturation (%) 50.8 ± 12.8 Right ventricular stroke-work index (g/m 2 /beat) 6.9 ± 3.3 Right ventricular failure risk score, n (%) ‡ ≤3 31 (89) 4-5 2 (6) ≥5. 5 2 (6) Plus-minus values are mean ± SD.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Assist Devices Improve Functional Class without Normalizing Peak Oxygen Consumption

Benton¹,

Sayer

Nair

et al. 2015

ASAIO Journal

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Heart failure patients supported with left ventricular assist devices (LVAD) enjoy improvements in functional capacity and quality of life. We reasoned that such improvements in exercise capacity should be reflected in an objective increase in peak oxygen consumption as measured by cardiopulmonary exercise testing (CPET). We performed a retrospective review of all recipients of a HeartMate II LVAD at our center from June 2009 to June 2012 who completed CPET. Thirty-seven patients completed CPET an average of 6 months after implantation. Of these, 10 patients had CPET performed before LVAD implantation. Overall, 91.4% of patients improved by at least two New York Heart Association classes, with 34.3% improving by three classes. Postimplant VO2 max was significantly less than predicted (14.7 ± 3.1 vs. 29.8 ± 6.6 ml/kg/min, p < 0.001; percent-predicted 51% ± 12%). For 10 patients with pre- and post-implant studies, VO2 max increased significantly from 11.6 ± 5.0 to 15.4 ± 3.9 ml/kg/min (p = 0.009). VO2 max improves significantly with LVAD support but fails to normalize to predicted values, in spite of improvements in functional class. The severity of preimplantation heart failure does not associate with the degree of VO2 max improvement.

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Chronotropic Incompetence and Abnormal Heart Rate Recovery Early after Left Ventricular Assist Device Implantation

Abstract: LVAD patients present an impaired CR and an abnormal HRR(1) after implantation, indicating significant cardiac autonomic abnormalities. These alterations seem to remain unaltered 3 months after LVAD implantation.

Cited by 40 publications

References 41 publications

Exercise Capacity and Functional Performance in Heart Failure Patients Supported by a Left Ventricular Assist Device at Discharge From Inpatient Rehabilitation

Exercise Capacity and Functional Performance in Heart Failure Patients Supported by a Left Ventricular Assist Device at Discharge From Inpatient Rehabilitation

Recurrent orthostatic syncope due to left atrial and left ventricular collapse after a continuous-flow left ventricular assist device implantation

Left Ventricular Assist Devices Improve Functional Class without Normalizing Peak Oxygen Consumption

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