Key result
Exercise training boosts peak power ~166% in one LVAD patient via peripheral and ventricular improvements.
Why the study?
The mechanisms underlying training-induced improvements in exercise capacity in LVAD-assisted cardiogenic shock patients are unknown.
Does 6-week exercise training improve hemodynamic, metabolic, and hormonal parameters in a cardiogenic shock patient with an LVAD?
Case Report (n=1)
Does 6-week exercise training improve hemodynamic, metabolic, and hormonal parameters in a cardiogenic shock patient with an LVAD?
In a single LVAD patient, 6 weeks of exercise training improved exercise capacity and left ventricular hemodynamics, though right ventricular function at maximal exercise warrants caution.
Exercise training may boost capacity in LVAD patients; hypothesis-generating and should not yet change practice.
PURPOSE: The mechanisms of the training-induced improvements in left ventricular assist (LVAD) patients are unknown. METHODS: We measured the hemodynamic, gas exchange, and metabolic and hormonal effects of 6-wk exercise training in a cardiogenic shock patient who was assisted by an LVAD. RESULTS: After training, the peak power and VO2 increased by 166% and 56%, respectively (80 W and 16.1 mL x min(-1) x kg(-1)), whereas the ventilatory drive decreased. Although the LVAD output increased little with exercise, the systemic cardiac output rose (adequately for the VO2) from 5.91 and 4.90 L x min(-1) at rest to 9.75 and 9.47 L x min(-1) at peak work rate, before and after training, respectively. Thus, the left ventricle ejected again through the aortic valve. Unloading and/or retraining resulted in a left ventricular filling pressure decrease. Although the right ventricular ejection fraction increased with exercise, it decreased again at the maximal load after training. For a given work rate the arterial lactate, the norepinephrine (NE) and epinephrine (E) concentrations fell after training, but the enhanced maximal work rate elicited higher NE and E concentrations (4396 and 1848 pg x mL(-1), respectively). The lack of right ventricular unloading might have kept the atrial natriuretic peptide higher after training, but the blood cyclic GMP and endothelin were lower after training. CONCLUSION: In an LVAD patient, retraining returns the exercise capacity to the class III level by peripheral and left ventricular hemodynamic improvements, but the safety of maximal exercise remains to be proven in terms of right ventricular function and orthosympathetic drive.
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Mettauer et al. (2001) conducted a case report in Cardiogenic shock assisted by a left ventricular assist device (LVAD) (n=1). Exercise training vs. Baseline (before training) was evaluated on Hemodynamic, gas exchange, metabolic, and hormonal effects (including peak power and VO2). In a single LVAD patient, 6 weeks of exercise training increased peak power by 166% and VO2 by 56%, returning exercise capacity to class III level via peripheral and left ventricular improvements.
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