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CLINICAL STUDY: HEART FAILURE

Exercise performance in patients with end-stage heart failure after implantation of a left ventricular assist device and after heart transplantation

An outlook for permanent assisting?

Nicolaas de Jonge, MD^a, Hans Kirkels, MD, PhD^a, Jaap R. Lahpor, MD, PhD, Corinne Klöpping, MD^a, Erik J. Hulzebos, MSc, Aart Brutel de la Rivière, MD, PhD and Etienne O. Robles de Medina, MD, PhD, FACC^a

^a Heart Failure and Heart Transplantation Unit, University Medical Center Utrecht, Utrecht, The Netherlands
Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
Department of Physical Therapy, Heart Lung Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands

Manuscript received June 1, 2000; revised manuscript received February 13, 2001, accepted February 26, 2001.

Reprint requests and correspondence: Dr. Nicolaas de Jonge, Heart Failure and Heart Transplantation Unit, Heart Lung Center Utrecht, University Medical Center, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
n.dejonge{at}azu.nl

OBJECTIVES

We sought to study exercise capacity at different points in time after left ventricular assist device (LVAD) implantation and subsequent heart transplantation (HTx).

BACKGROUND

The lack of donor organs warrants alternatives for transplantation.

METHODS

Repeat treadmill testing with respiratory gas analysis was performed in 15 men with a LVAD. Four groups of data are presented. In group A (n = 10), the exercise capacities at 8 weeks and 12 weeks after LVAD implantation were compared. In group B (n = 15), the data at 12 weeks are presented in more detail. In group C (n = 9), sequential analysis of exercise capacity was performed at 12 weeks after LVAD implantation and at 12 weeks and one year after HTx. In group D, exercise performance one year after HTx in patients with (n = 10) and without (n = 20) a previous assist device was compared.

RESULTS

In group A, peak oxygen consumption (O₂) increased from 21.3 ± 3.8 to 24.2 ± 4.8 ml/kg body weight per min (p < 0.003), accompanied by a decrease in peak minute ventilation/carbon dioxide production (E/CO₂) (39.4 ± 10.1 to 36.3 ± 8.2; p < 0.03). In group B, peak O₂ 12 weeks after LVAD implantation was 23.0 ± 4.4 ml/kg per min. In group C, levels of peak O₂ 12 weeks after LVAD implantation and 12 weeks and one year after HTx were comparable (22.8 ± 5.3, 24.6 ± 3.3 and 26.2 ± 3.8 ml/kg per min, respectively; p = NS). In group D, there appeared to be no difference in percent predicted peak O₂ in patients with or without a previous LVAD (68 ± 13% vs. 74 ± 15%; p < 0.37), although, because of the small numbers, the power of this comparison is limited (0.45 to detect a difference of 10%).

CONCLUSIONS

Exercise capacity in patients with a LVAD increases over time; 12 weeks after LVAD implantation, O₂ is comparable to that at 12 weeks and one year after HTx. Previous LVAD implantation does not seem to adversely affect exercise capacity after HTx.

Abbreviations and Acronyms   AT = anaerobic threshold   CI = confidence interval   HTx = heart transplantation   LVAD = left ventricular assist device   NYHA = New York Heart Association   RQ = respiratory exchange ratio (CO2/O2)   E = minute ventilation   CO2 = carbon dioxide production   O2 = oxygen consumption

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