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

Abstract

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...

Changes in Total Cardiac Output and Oxygen Extraction During Exercise in Patients Supported With an HVAD Left Ventricular Assist Device

“…In contrast, maximum exercise capacity in the CPET remained considerably more limited, with a peak work load of ∼65 watts (40% of predicted) and a peak VO 2 of 10.9 mL/kg/min (39% of predicted). Similarly, low values had already been observed in other studies and are well known in this patient group.…”

“…Functional performance measured by 6MWD was good, at 403 m (68% of predicted). Overall, the observed values were similar or slightly higher to those observed in comparable studies (8,(31)(32)(33)(34). Patients were able to manage sub-maximum exercise levels successfully without problems.…”

Exercise after Heart Transplantation: Typical Alterations, Diagnostics and Interventions

“…16-20 ml/kg/min is usually measured, corresponding to around 60-70 % of predicted values [35]. Of course this is considerably better than in the phase directly before HTX [90] and also better than results after LVAD implantation [91,92], but it still remains reduced compared to healthy patients. Significantly better values can be achieved only in individual patients, sometimes even at the level of high-performance sports activity [93].…”

Using Physical Function to Predict Hospital Readmission within 1 Year in Patients with Heart Failure

“…The 6MWT is a safe and simple evaluation that can be performed without a large walking space or special equipment. 31) Furthermore, the 6MWT is a prognostic predictor in patients with HF fitted with a left ventricular assist device 43,44) and those with transcatheter valve implantations. 45,46) Therefore, the 6MWT can be applied widely, not only for the evaluation of physical therapy in CR, but also for prognostic prediction in the clinical setting.…”