Heart transplant patients achieved a significantly greater functional improvement during cardiac rehabilitation compared to LVAD patients (28.8% vs 22.3% increase in predicted 6-minute walk distance).
Observational (n=97)
Open-label
No
Are there differences in biochemical markers between heart-transplanted and LVAD-implanted patients during cardiac rehabilitation, and do they associate with rehabilitative outcomes?
Differences in biomarker profiles, particularly dangerously low IGF-1 in LVAD patients, may contribute to their lower rehabilitative outcomes compared to heart transplant patients.
Absolute Event Rate: 28.8% vs 22.3%
p-value: p=<0.05
Heart transplant (HTx) and left ventricular assist device (LVAD) implant are the best options for symptomatic end stage heart failure, but LVAD patients show lower rehabilitative outcome than HTx patients. To investigate the causes, we compared biomarkers levels and their association with rehabilitative outcome in 51 HTx and in 46 LVAD patients entering the same cardiac rehabilitation program. In both groups, routine biomarkers were measured at start (T1) and end (T2) of cardiac rehabilitation while homocysteine, leptine and IGF-1 were measured at T1 only. HTx patients had lower lymphocyte, platelets, glucose, total proteins and albumin at T1; differences with LVAD patients vanished during rehabilitation when new cases of diabetes were observed in HTx. By contrast, total cholesterol, LDL and HDL fractions, leptin and IGF-1 were higher in HTx patients. The increase from T1 to T2 in six-minute walking test distance, measure of functional rehabilitation outcome, was positively associated with homocysteine and IGF-1 levels in HTx patients. In conclusion, during rehabilitation care should be paid to the early occurrence of dyslipidemia and hyperglycemia in HTx patients, which also require a proper protein dietary support. IGF-1, dangerously low in LVAD patients, might contribute to their lower rehabilitative outcome.
Racca et al. (2018) conducted an observational in End-stage heart failure (n=97). Heart transplantation vs. Left Ventricular Assist Device (LVAD) implantation was evaluated on Increment in 6-minute walk distance percentage of predicted value (6MWD%) (p=<0.05). Heart transplant patients achieved a significantly greater functional improvement during cardiac rehabilitation compared to LVAD patients (28.8% vs 22.3% increase in predicted 6-minute walk distance).